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CLASS OF 1900 

















During the past twenty-five years I have been en- 
gaged in the practical Avork of ministering to the 
needs of the insane. This work has resulted in a 
gradual development of that form of treatment 
which has been designated as **The Hospital Idea.'' 
In other words, the asylum has given place to the 
hospital in the protection and restoration of mental 
invalids. The fact is now generally recognized that 
the insane man is a sick man, and needs for his com- 
fort and cure the application of such means as are 
ordinarily used for the benefit of the sick in a modem 
general hospital. Acting under this belief, our 
patients have been favored with such treatment as 
may be best exemplified by skilled physicians, trained 
nurses, and hospital methods and appliances. At 
the Middletown State Homeopathic Hospital there 
have been afforded not only hospital measures for 
the recuperation of the mentally sick, but the 
indicated homeopathic remedy has been applied 
with conscientious fidelity in each case. Individual- 
ization, and hospitalization, and homeopathic treat- 
ment, have been the methods pursued in the in- 
stitutions under my charge during the past quarter 
of a century. This work emodies, in a series of 


lectures, a long experience in working for the good 
of the insane. In it I have tried to explain the 
nature of the disease under consideration; also 
its causes, its tendencies, and its conclusions under 
favorable treatment. 

This work is not an exhaustive treatise upon in- 
sanity. It consists simply of a few ** blaze marksj" 
guiding the way through the wilderness of mental 
disorder, and into the sunny fields of health. If it 
shall become an aid to the medical student in the 
acquisition of knowledge, and to the busy practi- 
tioner in the care and cure of the sick, then its pur- 
pose will have been accomplished. 

The Author. 

Middletowfiy N. K., April y igoi. 




Its coverings, divisions and subdivisions, weight functions, 
localization of functions, operations, uses abuses, and capa- 
bilities . . . . - 9 to 30 




Definition. Causes, inherited and acquired. Evidences, 
avoidance, and treatment 31 to 51 



What is sleep ? The Condition for sleep. The natural causes 
of sleep. Causes of insomnia. Suggestions for the induction 
of sleep. Remedies 52 to 68 



History. Classification of insanity. British classification. 
American Classification. Theories, Definitions. Requirements 
for commitment. Contra indications of commitment . 69 to 93 



Defitition. Causes. Forms. Symptoms, courses and cases. 
Delusions. Prevalence and prevention. Pathological states. 94 to 1 26 



Characteristics. Causes. Forms. S3anptoms, courses and 
cases. Pathological states . . . . . 127 to 158 




Nature, Forms, Causes, sjrmptoms and treatment of acute 
dementia. Chronic dementia. Masturbatic dementia. 
Syphilitic dementia. Epileptic dementia. Organic demen- 
tia. Alcoholic dementia. Senile dementia. Pathological 
states i59toi8i 




History. Synonyms. Stages. Cases. Causes. Pathology. 
Diagnosis, prognosis and treatment. Prevention . . 182 to 210 



At home. In sanitariums or State hospitals. Means for 
treating the insane, kindness and gentle discipline, rest in 
bed, enforced protection, exercise, amusement and occupa- 
tion, artificial feeding, dietetics, moral hygiene, operations, 
the hospital idea . . . . . . . 211 to 231 



How to prescribe. Principal remedies for the treatment of 
melancholia, mania, dementia, and general paresis - 232 to 245 


Site. Construction of buildings. Solariums. Ventilation, 
heating and lighting. Protection against fire. Furnishings 
and decorations. Congregate and ward dining-rooms. Kit- 
chen and bakery building. Boiler house, dynamo plant and 
laundry. Cold storage building. Outbuildings for stock of 
various kinds 245 to 263 


Comprising the leading remedies and their principal indica- 
tions in the treatment of mental disorders . . . 264 to 341 



Three thousand years ago, more or less, there 
\srere inscribed above the portals of the temple of 
Apollo at Delphi these immortal words, "Gnothi 
Seauton" {\vSiOi o-cavrdv), which, being translated from 
the original Greek into the present vernacular of the 
United States, means **Know Thyself/* That we 
may know ourselves better than before, let us con- 
sider to-day the human brain, its functions, its uses, 
its abuses, and its capabilities. 

No one can presume to unfold in all their fullness 
and perfection the mysterious workings and the 
marvelous mechanism of the human brain. So intri- 
cate a subject can never be fully understood except 
by the Infinite Mind that planned and brought into 
action this rarest product of all creation. Still, 
possibly, we may comprehend in a measure the 
mechanism of the brain, and by carefal study come 
to understand in some slight degree the uses of that 
w^onderful organ, and also the disastrous effects of 
its misuse. 

We shall proceed to strip off the coverings of the 

head and pursue our searches to the core, explaining 

as we pass along, in brief, each part as we find it. 

This work has, I presume, already been performed 

by your professor of anatomy, and I shall merely 

enumerate the component parts of the head in this 

connection for the sole purpose of drawing your 


attention to a material structure as an organ of the 
mind, and then pass to a contemplation of the sub- 
tle processes of the mind itself. 

The coverings of the brain are three in number : 

1. The periostic (above the bone), — namely, the 
hair, scalp, and muscles. 

2. The bony cranium. 

3. The sub-osseous, — namely, the membranes ly- 
ing beneath the skull and over the cerebral mass. 

The scalp is a thick, tough, tenacious covering, 
forming the base and ground-work whence springs 
that luxurious adornment, the human hair. The 
scalp is thicker than the skin of any other portion of 
the body. A thick scalp protects the brain from 
accidental injuries. It is also supposed to prevent a 
too rapid in-pouring of ideas upon the brain. The 
scalp is attached to the skull by means of the occipi- 
to-frontalis muscle. The latter covers the skull, and 
has attachments along the crest of the brow, over 
the eyes, and at the occiput, or back part of the 
head. It is by means of this muscle that the brow^s 
are elevated in token of surprise, or corrugated as an 
evidence of displeasure or chagrin. The occipito- 
frontalis muscle is thin even at its extremities or 
points of insertion. Over the top of the head it is 
but little more than a thick membrane or flattened 

Beneath the scalp and its controlling muscle, we 
arrive at the skull, an egg-shaped, bony case, flat- 
tened underneath, the forepart of which gives at- 
tachments to the face. The skull is composed of flat 
bones consisting of two layers, an outer and an 
inner table, and a spongy tissue, known as diploe, 
between them. Where the walls are very thin there 
is but a single layer. The vault of the skull presents 


two minute openings (the parietal foramina) for the 
passage of small veins. At the base are many open- 
ings for the transmission of nerves, and for other 
purposes. The skull-cap proper is very strong, and 
built to resist heavy blows. The base of the skull is 
relatively weak and easily broken. The various 
bones of the skull are laced or interlaced together by 
what are called the sutures in such a way as to 
oppose the tearing off of any bone by force acting in 
a single direction. 

On removing the skull-cap we arrive at the three 
sub-osseous coverings called membranes. The first, 
or that next the skull, is termed the dura mater, 
which, as compared with the others, is thick and 
exceedingly tense and firm, resembling in some slight 
degree a drumhead or piece of parchment. Except- 
ing on the crown, it is closely adherent to the skull, 
with which it is very intimately associated, as 
through its outward surfaces the minute vessels 
w^hich supply the bony casing of the brain with 
blood find their way. The inner surface of the dura 
mater, that is, the surface next the brain, is smooth 
and oily, so to speak, thus relieving the slight fric- 
tion which takes place between the brain and its 
protecting citadel, as the former swells into action 
under the pressure of excitement or subsides into a 
gratefiil calm during its appropriate periods for re- 
pose. The dura mater forms still another protection 
for the brain ; its density and firmness resisting with 
vigor all encroachments from without, the splintered 
fragments of a fractured skull even being held in 
abeyance in many instances. By these appropriate 
means the most vital organ of the body is protected 
from fatal injuries. 

The second membrane is termed the arachnoid 


from its supposed resemblance to a spider's web. It 
is a single layer of thin, delicate, connective tissue 
overhanging the convolutions of the brain, and div- 
iding into two the spaces between the organ and 
the skull. The outer of these is called the subdural 
space, and the inner the subarachnoid. It was for- 
merly supposed that the arachnoid membrane 
formed a close sac like the pleura, which envelops the 
lungs and lines the walls of the thorax, but investi- 
gations have tended to disprove this theory. What 
was supposed to be its outer, or reflected portion, is 
really one of the layers of the dura mater. The chief 
uses of the arachnoid seem to be to envelop and in 
some measure to protect the brain, and to secrete a 
fluid for the purpose of keeping it in a state best 
adapted for the proper performance of its functions. 

The third membrane, which is discovered as we 
pursue our explorations, is termed the pia mater, or 
delicate mother. This, too, like the arachnoid, is a 
layer of connective tissue, but it performs the work 
of holding together vast numbers of small arteries 
and veins that carry on, to a large extent, the circu- 
lation of the brain. This membrane is adherent to 
the brain surfaces, covering closely the convolutions 
and dipping into the sulci or spaces between them. 
As the blood vessels pass into the brain from the pia 
mater like so many little rootlets, the membrane is 
of course fastened snugly to that organ. 

The brain itself is divided into hemispheres. These 
hemispheres are subdivided into lobes. The hemis- 
pheres are separated by the great longitudinal 
fissure which extends throughout the length of the 
cerebrum in the middle line, reaching down to the 
base of the brain in front and behind, but inter- 
rupted in the middle by a broad band of white 


matter termed the corpus callosum. This band 
unites the hemispheres like the firm mass which 
united the Siamese twins. 

Each half of the brain is divided into what are 
called the frontal, parietal, occipital and temporal 
lobes ; and for a fifth lobe we have what is termed 
the Island of Reil. 

After removing the coverings we come to the con- 
volutions. These are separated from each other by 
depressions called sulci. It is supposed that the 
deeper the sulci, the greater the brain power. This 
is not always true, but the deeper the sulci the 
greater the opportunity for a deposit of gray 

Upon the outer surfaces of the convolutions, and 
on the sides and bottom of the sulci, is a gray mat- 
ter called the cortical substance. In the gray matter 
there are five or six layers of nerve cells. Many of 
these cells are shaped like a pyramid, while some are 
round and some are elongated. The nerve cell has 
a nucleus, a plasma, and a surrounding pellicle or 
skin, and also outreaching tentacles or arms. The 
entire outfit is called the neuron. Within the corti- 
cal substance we find the white fibers which are in 
reality the connecting wires of communication 
between the nerve extremities of the body and the 
neurine batteries of the brain. The nerve fibres con- 
vey impressions to the cells, and the cells which 
receive these impressions act according to the 
impression which is made. 

Besides nerve cells and nerve fibers there is a sub- 
stance in the brain called the neuroglia. The neu- 
roglia "is a transparent, nucleated, homogenous, 
non-fibrillated matrix, somewhat resembling the 
fibrillated connective tissue of the spinal cord." 


Supposing you were to put a lot of berries on some 
strings, and then put them into a glass jar with the 
ends of the strings hanging over the mouth of the 
jar, and then fill in the interstices with some syrup, 
this syrup might represent or typify the neuroglia. 
After the Almighty had constructed the nerve cells 
which are the homes and centers of mental activity, 
and after He had connected them by nerve fibers 
with the great organs and surfaces of the body, that 
is, with the external world, He filled up the cracks 
with neuroglia, which is simply connective tissue, 
and other supporting material. 

Histologically, you will remember that the cere- 
bral mass is composed of gray matter filled with 
cells of many kinds, of white matter (that is, white 
nerve lines of communication), and of neuroglia, 
which is a nucleated mass thrown in for the support 
of the rest of the brain. 

Having plodded through the brain, we arrive at 
the base, and, as we expose it to view, we see the 
longitudinal fissure, the corpus callosum, and its 
peduncles, the lamina cinerea, the olfactory nerve, the 
fissure of Sylvius, the anterior perforated space, the 
optic commissure, the tuber cinereum, the inftmdi- 
bulum, the pituitary body (which is said to be the 
seat of the soul), the corpora albicantia, the poste- 
rior perforated space, and the crura cerebri. Now I 
trust that you will never forget any of these since I 
have taken the trouble to bring them to your notice. 

From the base of the brain are given off twelve 
pairs of nerves. These are called nerves of sensation, 
motion, and special sense, and are the mediums 
through which impressions, both external a-nd inter- 
nal, are conveyed to the brain, and through these all 


orders of the mind to the body are conveyed for 

The functions of seeing, smelling, tasting, and 
hearing, are performed by the optic, olfactory, tri- 
facial, and glosso-pharyngeal nerves. Portions of 
those just named, and the remainder of the twelve, 
constitute the nerves of sensation and motion. 
Some anatomists name but nine pairs of nerves. We 
prefer a division of twelve, and shall enumerate 
them as follows : 

1. Olfactory, 5. Trifacial, 9. Glosso-pharyngeal, 

2. optic, 6. Abducens, 10. Pneumogastric, 

3. Motor oculi, 7. Facial, 11. Spinal accessory, 

4. Pathetic, 8. Auditory, 12. Hypoglossal. 

There are in the brain five ventricles. The chief of 
these are the lateral, and those of lesser importance 
are the third, fourth, and fifth. The lateral are large 
and occupy a considerable part of the cerebral 
center, running in a general w^ay lengthwise along 
the base, but always, according to Hogarth's line of 
beauty, on a curve. The ventricles are important, 
because we find in them the choroid plexuses which, 
when diseased, tend to produce sleeplessness, and 

The next in importance to the lateral ventricles is 
the fourth ventricle. This is bounded in front and 
below by the medulla, and the reverse of the pons 
which constitute its floor ; above and behind by the 
cerebellum ; in front by the valve of Vieussens, and 
the superior peduncle ; on the side by the restiform 
bodies, part of the pons, and the lateral lobes of the 
cerebellum. It is said that diabetes is due to some 
diseased condition found in the floor of the fourth 

The third ventricle extends anteriorly along the 


base of the brain to and between the optic thalami . 
The space between the septum lucidum, w^hich is 
very slight, is called the fifth ventricle. 

All the true ventricles communicate with one 
another; the two lateral with the third, the third 
with the fourth at the aqueduct of Sylvius, the 
fourth with the central canal of the spinal cord and 
vsrith the subarachnoid space. 

The significance of the ventricles lies in the fact 
that effusions occur in them and thus the action of 
the brain is either impaired, or destroyed. 

The cerebellum, or little brain, is supposed to pre- 
side over the functions of co-ordination, as they 
relate to equilibrium, harmony and the symmetrical 
action of the two parts of the body. 

The medulla oblongata is the butt end of the 
spinal cord. The band of union betw^een this end of 
the cord, the cerebellum, and the cerebrum is termed 
the pons varolii. 

Viewing the brain from the standpoint of develop- 
ment, we find that it is divided into three parts : 

1. The forebrain, consisting of the olfactory 
lobes, the cerebral hemispheres, and the parts sur- 
rounding the third ventricle. 

2. The midbrain, consisting of the corpora 
quadrigemini, and the crura cerebri. 

3. The hindbrain, consisting of the cerebellum, 
the pons varolii, and the medulla oblongata. 

This is the classification of Huxley, and is simple 
and easily remembered. 

The physiological peculiarity of the brain is that 
it selfishly requires for its proper nourishment about 
one-sixth of all the blood in the entire body. 

The brain in the new-bom infant is said to weigh 
about ten ounces. The average weight of the adult 


brain ranges from forty to forty-eight ounces. The 
brain of the celebrated Cuvier weighed over sixty- 
four ounces, that of Abercrombie sixty-three, while 
those of Agassiz, Daniel Webster, and a common- 
daylaborer weighed about fifty-three ounces each. 
The size of any given brain, all other things being 
equal, determines its power. But the quality must 
also be considered. This varies greatly. The brain 
of Gambetta weighed but thirty-six ounces, while 
the brain of a United States idiot weighed sixty- 
seven ounces. The difference in the brain power de- 
pends not alone upon the size, but also upon the 
quality. The quality of the brain can generally be 
determined by its achievements. 

Great differences of opinion have existed with re- 
gard to the period at which brains attain their full 
size. Sir William Hamilton asserted that the brain 
reached its maturity, as to size, at the age of seven 
years. Other celebrated writers have claimed that 
the brain matures between the twentieth and 
thirtieth years. We believe that under ordinary 
usage the brain matures gradually with the body, 
and so long as the general system maintains 
growth, so long the brain may continue to grow. 
The head of Napoleon was small in youth, but ac- 
quired in after life an enormous development. So it 
seems that the force of an untiring and active brain 
may assert itself even against its bony environ- 

We come now to speak of the functions performed 
by the brain. These may be divided into two 
classes : (1) Those which preside over and direct the 
various motions of the body, physical functions, so 
to speak; and, (2) the higher or mental functions, 


wherein are involved cognizance, memory, and judg- 

The action of the brain, in its relation to the 
body, may be illustrated by comparing it to the ac- 
tion of a spider in relation to its web. This famous 
animal is usually found at home in the most central 
portion of its self-constructed domicile. It may be 
apparently asleep, but if you touch ever so lightly 
one of the filaments of the spider's web, he instantly 
takes notice of the fact, and seeks to repair the in- 
juries which have been wrought. So the brain 
stands like a sleepless Cerberus in the centre of the 
much-diverging nerve fabric, and if you prick a nerve 
extremity the shock is vibrated with lightning-like 
rapidity to the brain, and from it goes forth the 
order to the muscular guardians of the injured part 
to hold the fort, or to beat a retreat, as may seem 
best. A good illustration of nerve action is when a 
boy sits down upon a bent pin, and then gets up 

Let us now attend to the localization of those 
fimctions of the brain which direct and influence the 
body. By applying the galvanic current to different 
portions of the exposed brain in the case of a 
monkey, and carefally noting the effects, it was 
observed and determined that the excitement of one 
part of the brain caused movements of the lower 
limbs of the opposite side, as in walking. By stimu- 
lating another portion of the brain, the muscles of 
the forearm became flexed, w^hile stimulation of an- 
other part would cause protrusion of the tongue, 
etc. Repeated trials enabled the experimenters to 
mark out on the brain the exact limits of these 
physical fimctions, and within the circles thus de- 
scribed, by due stimulus, action in some particular 


part of the body was invariably excited. Thus were 
the ftinctiotts of the brain in their relationships to 
the functions of the body discovered and localized. 

It was also discovered that certain portions of 
the brain were not used in thus controlling the ac- 
tions of the body. These unused portions are found 
in the fore and hind parts of the brain. It is gener- 
ally believed that in the anterior portion of the brain 
the intellectual workings are carried on, while in the 
hind part of the brain are located the centers of the 
emotions, the passions, and the appetites. 

It is an interesting fact that each portion of the 
brain has its specific and special duty to perform. 
This fact has been demonstrated by the experiments 
of Fleurens, Longet, Velpeau, Ferrier, Hitzig, and 
others. By removing successively portions of the 
brain in some of the lower animals, the powers of 
what remained were determined. When the upper 
lobes of the brain were removed from a pigeon, that 
bird was deprived of the powers of memory, and 
w^ill ; but it could fly when thrown into the air, it 
could be roused by a gentle push or pinch, by a light 
flashed before its eyes, by ammonia held near its 
nostrils, by a pistol discharged close to its head. 
By removing another layer of brain tissue the 
faculty of sight is destroyed, while hearing remains. 
By removing still another layer the faculty of hear- 
ing is destroyed ; and again, the power of motion is 
paralyzed, and so on to the end of the chapter. 
When we come to excise that center from which 
the pneumogastric nerve springs, then the heart and 
lungs are paralyzed and the animal dies. This is 
true in all cases except that of the frog. A frog can 
live for a short time by cutaneous respiration, for 
scientific purposes, of course. The frog may be de- 


capitated, and all nerve centers removed except 
those located in the spinal cord, and then if a por- 
tion of the belly be irritated with a drop of acid, an 
attempt will be made by the frog to remove the irri- 
tating substance by rubbing it off with his right leg. 
Now cut off the right leg and you will see an at- 
tempt to reach the irritated spot by the stump. 
Not succeeding, the animal will pause and think it 
over with his spinal cord, and then you will see him 
try to remove the acid with his left leg. 

We now pass to a consideration of the brain as a 
seat of mental power, — the temporal kingdom of the 
mind, the earthly tabernacle of the immortal soul. 

Within the convolutions of the brain rest not only 
the power of guiding and propelling the physical 
forces, but, also, therein is the seat of a higher power 
which enables man to control not only his own 
actions, but to influence and direct the actions of 
others ; to oppose successfully his intellectual vigor 
and prowess against the crude strength of the lower 
animals, and against the combative elements of 
earth and sea and air. 

Man's brain, in the first place, takes cognizance 
of external things through perception or impression. 
Next he stores away the fruits of cognizance in the 
wine press and vaults of memory. From these come 
forth at last the rich essence of judgment, the final 
result of a subtle and mysterious process. The will 
executes the mandates of the judgment. 

The ancients thought that the brain was but a 
useless mass of crude matter, a sort of overgrown 
clam, a mountain snow-cap to keep the rest of the 
body cool. The modem student finds that the brain, 
wrhich the ancients despised, has become the chief 
and most important organ of the human body. The 


human mind, the occupant of this brain, is the 
marvel and the mystery of creation. It is swayed 
by every flitting passion or impression, and yet it is 
held in steady poise by the calm monitions of reason, 
of cultivated judgment, and of developed will. In 
these respects it resembles those wondrous rocking- 
stones reared by the ancient Druids. You remember 
that they were so finely balanced that the finger of a 
child could vibrate them to their centers, and yet they 
vsrere so firmly poised that the might of an army 
could not move them from their base. So it is with 
the human mind w^hich has been thoroughly trained, 
carefiiUy cultured, and kept by its owner as a pearl 
without price. The smile of a child can sway it to 
and fro, while the fagot of martyrdom could not 
change one jot or tittle of its firm determination. 

Let us see how the brain works during the evolu- 
tion of thought. It is claimed that there are two 
classes of intellectual faculties, — the knowing, and 
the reflecting. The knowing faculties are individu- 
ality, form, size, weight, coloring, locality, etc. The 
reflecting faculties are comparison, and causality. 
Each faculty has, it is said, a separate portion of the 
brain for its home. The memory belongs to each 
faculty. Hence there are as many kinds of memory 
as there are homes for the knowing and reflecting 
faculties. Sometimes by reason of localized brain 
disease a person may lose the power of recalling a 
name, or place, or event, and yet may be able to 
exercise his memory with regard to all the faculties 
except the one which has been disturbed by disease. 

Memory is simply a retentive attribute or power 
of the mind. The best view to take of memory is to 
regard it as the holding of a feeling, a thought, or 
a purpose in the continuous life of the mind. Every 


thinking act continues, every choice and purpose 
likewise remain part of the mind's activity. The 
law of retentiveness in the mind imposes three condi- 
tions for a good memory. They are found : 

1. In the subject matter of remembrance, 

2. In the relationship of each thing remembered 
to other things in the mind, and, 

3. In the care of the mind itself. 

The first condition is that the mind accepts read- 
ily only what it most needs or wishes to use ; there- 
fore, you should get good things to remember. The 
second is to associate them carefiiUy with things 
already remembered in such a manner that they 
may be easily recalled. The third condition for 
securing a good memory is to give your full atten- 
tion, without day-dreaming or mind-wandering, to 
the subject that you may wish to memorize. 

Professor Bain classifies mental activities as fol- 

1. The senses — ^that is, the five senses, 

2. The intellect, or the mental processes w^hich are 
developed between impressions on the one hand and 
determination on the other, 

3. The will, with which the judgment is closely 

4. The emotions. 

The products of the senses are called sensations. 
The products of the intellect are ideas, beliefs, im- 
aginings, derived from processes of reasoning and 
understanding and arriving at the conclusion of 
judgment. The products of the will are volitions; 
and the products of the emotions are feelings and 

The first step in mental activity is self-conscious- 
ness. The mind takes cognizance of an impression 


produced upon the brain by any of the j&ve senses. 
When the brain receives an impression from any 
source, and the mind becomes conscious of it, then 
there is formed within the mind what are called 
perceptions. The power of perceiving and comparing 
is called the intelligence. The intelligence is the 
mind's faculty of knowing. After receiving various 
and repeated impressions, and after forming numer- 
ous comparisons of objects which we often see, we 
find at last that there has been developed an auto- 
matic function, so to speak, and this is known as 
intuition. Intuition is the faculty of internal percep- 
tion and internal comprehension. Intuition is a lim- 
ited sphere of mental phenomena. It is an incom- 
plete phenomenon. From this we pass on to a com- 
plete knowledge, and thus the faculty of thought is 
stirred into activity. Thought is the elaborative 
faculty, the comparative faculty, the faculty of rela- 
tionships. Well, we put several thoughts together, 
and let them have a warlike struggle, and this 
process of fighting, of thoughts rubbing against 
each other, and concluding either victory or defeat, 
we call reasoning. After this fight of thoughts has 
been carried on until final facts or conclusions are 
distinguished from primal inference, after the good 
has been distinguished from the evil, and truth from 
falsehood, after the monkey and the parrot have 
both got through, there is brought in a verdict of the 
whole matter, and this is called judgment. Judgment 
is that faculty which enables the mind to ascertain 
truth by comparing facts and ideas. Judgment is the 
faculty of opinion put by the individual upon facts 
with which he has become acquainted, and upon 
ideas which have been generated within his own 
brain. A judgment having been formed, the wiU rises 

^ I 


and executes the mandates of the judgment. The will 
is the power of determining upon final action, and 
upon the will human achievement largely depends. 

Now remember that intellectual action of the 
mind works as follows : First, you have impression 
through one of the senses ; then perception of that 
impression, that is consciousness; then intuition, 
then thought, then reasoning, then understanding, 
then judgment, then will. 

Beyond the intellectual workings of the human 
mind, we have, as a compass to guide the will, what 
men call conscience. Theodore Parker, when a little 
boy, was tempted one day to kill a spotted tortoise, 
but a voice spoke to him and said **It is wrong." He 
looked around, and seeing no one, fled in great fear 
to his mother, and told her what he had heard and 
asked her w^hat it was that spoke to him in that 
way. The mother took the child in her arms, and 
said: **Some men call it conscience, but I prefer to 
call it the voice of God speaking in the soul of man. 
If you heed that little voice it will always guide you 

The will is swayed and impelled, or hindered, by 
what are called the emotions. The emotions have 
been subdived into feelings, and passions. The ex- 
tremes of feeling are termed pleasure, and pain. 
These vary through all grades of intensity, from the 
faintest flush of satisfaction, to the brightness of 
ecstatic joy; from the slightest cloud of discontent, 
to the stormiest violence of grief and agony. They 
intermingle with all the experiences and energies of 
the mind, intruding upon every affection, investigat- 
ing every movement of the intelligence, and animat- 
ing or disheartening every activity of the free w^ill. 
Passions are represented on the one extreme by love, 


and on the other by hate. When these are but par- 
tially developed, we may feel pity, or disgust, or con- 
tempt for objects about us. 

Emotions are sometimes awakened by the idea 
that things are true, or beautiful, or good. Such 
emotions are called the intellectual sense, the 
aesthetic sense, and the moral sense. Again, the 
emotions may be excited by the originality or new- 
ness of the idea. If new and incongruous, it is 
known as the emotion of the ludicrous. An emo- 
tion when vividly presented in bright language is 
termed repartee. 

Again, the mind is the parent of desires. Some 
may be normal and healthful, while others are ir- 
regular and morbid. Desires belonging to the physi- 
cal constitution are commonly known as appetites. 
Healthful appetites, when naturally satisfied, cease 
their craving, and disappear until the health and 
well-being of the body reawaken them. Unnatural 
appetites continue their demands for that which is 
unhealthy and injurious. The will is not always en- 
ergetic enough to subdue such appetites. Concern- 
ing unnatural appetites, Charles Dickens has de- 
clared that" vices are sometimes only virtues carried 
to excess.'' 

And, now, as we rehearse these various and 
numerous faculties of the mind, we come to the con- 
clusion that the mind is single, yet with a plurality 
of functions. It is the same mind that feels, that 
thinks, and that wills ; and in putting forth either of 
these functions it never entirely ceases from the 
others. Consequently, every mental state has some- 
thing of feeling, something of intelligence, and some- 
thing of volition, or endeavor. It is so with the 

body. The body puts forth simultaneously various 


fanctions of animal life. It breathes, it circulates its 
blood, it digests, it secretes, and it receives, and 
transmits sensations. Not one of these bodily func- 
tions need be suspended while the others are in exer- 
cise. The human mind works as a unit. One function 
may appear temporarily to overshadow by its 
prominence all others, and yet the other functions 
are by no means suspended. The various functions 
of the mind shade into each other with an infinitely 
varying degree of prominence, and thus give a kalei- 
doscopic character to the mental states. 

It needs but little reflection to conclude that the 
uses to which our brains must be subjected are both 
intricate and multitudinous. They have a priestly 
charge and oversight over those living temples so 
"fearfiiUy and wonderfully made'* by the hand of 
Infinite Wisdom; and they are likewise the tem- 
porary lodging places of the immortal soul. The 
brain is the great storehouse of fact and the factory 
of thought. It takes up by its inherent action the 
scenes and sounds by w^hich it is surrounded; it 
gorges itself upon the experiences of the past; it pro- 
trudes itself, through hope and imagination, upon 
the great undiscovered future. Within the serried 
ranks of cell and fibre, of matter gray and white, 
there is involved in meshes, too intricate to unravel, 
a mysterious union of the material and the imma- 
terial. The theories of the wisest are too feeble to 
express it, the explorations of the ages have failed to 
discover or explain in fall the unfathomable phe- 
nomena of mental action. Materialistic theorists 
find no satisfactory conclusions from their varied 
and persistent investigations - of the human brain 
and its marvellous workings. From action to in- 
action, from life to death, the search for the truth 


has been and is being most carefully made. The 
brain is the sheltering home of mentality, of im- 
mortal being, too, but you might as well count the 
rafters of a church, and from the enumeration thereof 
declare the character of the congregation therein 
assembled, as to attempt to educe from an examina- 
tion of the brain after death a conclusive theory as 
to the nature of man. And yet the investigation 
goes on, and the problem of human life will by-and- 
by be solved. Gradually the cause and effect of per- 
ception, impression, and ratiocination, will be surely 

The practical uses to which our brains are 
adapted are those of self-preservation and self-im- 
provement. With what critical care, then, should we 
begin and continue the exercise of that organ upon 
whose proper development and growth depend the 
life, the happiness, the prosperity, and progress of 
the individual possessor of so rare a gift ! The young 
should be taught to regard the brain in their posses- 
sion as the pearl of great price. Brain culture of the 
right kind should begin at the earliest possible period 
in life, and "should be continued without undue inter- 
ruption, until man bends his head low to escape the 
rafters in the western horizon. This does not mean 
hard study, but proper training in childhood. Our 
brains should always be used with moderation and 
steadiness, but with unswerving persistence. Upon 
this care and culture depends not only the growth of 
the individual, but, by such means are fortifications 
erected to repel the assaults of man's greatest enemy 
— ^insanity. 

The best uses of the brain are those in which all 
the forces of that organ are bent to the service of 


right, and are forever arrayed against the hordes of 

The worst abuse of the brain is a prostitution of 
its powers before the juggernaut of sin and error. It 
is a moumftd fact that great powers and great 
abuses are often found in close company. The exer- 
cise of these powers, and the exemplification of 
w^rong use are often manifest in the life and career of 
a single individual, and sometimes they are manifest 
in the acts of a community, or a nation. 

While we recognize the po^wers and achievements 
of the human mind, yet w^e can never see that mind 
at work. The wisest thought of the philosopher, or 
the finest conception of the poet, may produce no 
observable action of the brain. The school boy's 
determination to run a^sray from school may pro- 
duce as much effect upon his brain as Avas produced 
upon Caesar's or Napoleon's when one decided to 
cross the Rubicon, and the other to scale the heights 
of Saint Bernard. But while we cannot see the 
actual wrorkings of the human mind, ^ve are yet able 
to trace in history the effects of those workings. To 
attempt to measure the work of the brain in civiliza- 
tion would be but an attempt to measure civiliza- 
tion itself. A greater range of mental and moral 
perceptions, and a superior fineness of mental and 
moral culture, are really all that have been gained 
in the centuries of human life. I am speaking, of 
course, of the permanent possessions of the human 
mind. What is preserved in the intellectual life of 
the past in books, pictures, architecture, and sculp- 
ture, is an available aid of great value. But apart 
from this, something has been preserved of the 
strength and culture which habits of thinking pro- 
duce, and this is all that man can definitely claim as 


his own ; all else is outside of himself and may be 
destroyed. But while we all understand, abstractly, 
that the brain is the seat of intellectual life, and that 
it impels all human action and shapes all human 
destiny, yet there are few so well instructed that 
they would not be filled with surprise and wonder at 
what one man may do. In mingling with the masses 
of human beings, the thought impressed most forci- 
bly upon us is the Uttleness, the insignificance, of 
an individual life. Count a hundred of those you 
will first meet on your way to-morrow morning, 
and the chances are that the world would not fed 
the slightest loss if they were to be instantly swept 
out of existence ; nor would it lack anything of its 
intellectual acquisitions if they had never been. 
What more painfiil, humiliating illustration of man's 
littleness! But you can count a hundred names 
whose loss, if they should be taken from civilization, 
would make immeasurable mutilations. What 
empty shelves in our libraries ; what vacant spaces 
on the walls of our galleries of art; what grand 
structures, the inspirations of genius and of faith, 
would disappear! What rents would be made in 
laws, in constitutions, in religious creeds ! But more 
impossible to estimate than all else would be the 
weakening of the intellectual fibre, and the depletion 
of the intellectual strength, of the living brain. It 
is by considering these great men whose displace- 
ment would wrench the world ; it is by studying and 
trying to measure their work, that we come, in part, 
to appreciate the capabilities of the human brain. 
Biography when truthful, and the subject is noble as 
well as great, is one of the most useful of studies. 
Nothing else gives us such grand ideas of our nature, 
such consciousness of strength, such buoyancy of 


hope, such honorable pride. Nothing else fills us 
with such longings, or so stirs emulation, and stimu- 
lates action ; and nothing else imposes upon us more 
forcibly the importance of correct mental training. 

We have pointed out very briefly, some of the nor- 
mal functions of the brain and mind, in order that 
we may understand more readily those departures 
from the normal status which constitute the disease 
known as insanity. We shall in our next lecture 
seek to disclose those conditions, and impulses, and 
forces, which tend to the production of mental dis- 
order; "but that is another story." 






It has been truly said that ** man is the product of 
his antecedents multiplied by his environments." 
Our lecture to-day will concern both of these factors 
in the sum of human experience. 

Dr. Duncan, of Chicago, classifies babies under 
two heads,— namely, the **acid" and the '* alkaline;" 
and from such a physiological standpoint he argues 
new methods by which our infant population may 
be best trained in the way it should grow. Dr. 
Grauvogel, in his metaphysics of medicine, entitled 
"The Text Book of Homoeopathy," designates the 
various constitutions of the human body as **hydro- 
genoid," **oxygenoid," and "carbo-nitrogenoid." 
As inherent characteristics may be thus classified 
and designated, why is it not equally legitimate to 
specify other natural or acquired mental abnormal- 
ities by terms of a similar basic import? 

Mental abnormality is always due to either im- 
perfect or eccentric physical development, or to effects 
of inborn or acquired physical disease, or to injurious 
impressions, either ante-natal or post-natal, upon 
that delicate and intricate physical structure known 
as the human brain. Some physical imperfections 


more than others give rise to mental derangements. 
Some persons, more than others, when affected by 
any bodily ailment, tend to aberrated conditions of 
the mind. Some impressions, more than others, are 
peculiarly unfortunate by reason of their corroding 
eflfects upon the brain tablets of a sensitive mind. 
To these natural defects and unnatural tendencies, 
we apply, in a general way, the term "The Insane 
Diathesis. '* This is a state or condition in mental 
pathology corresponding to those diatheses so com- 
mon in physical pathology, namely, the scrofalous, 
the cancerous, the scorbutic, the rheumatic, the 
gouty, and the calculous. The insane diathesis is a 
general term applying to all those conditions which 
tend to the inception and growth of mental 
unsoundness. This diathesis may be either inherited 
or acquired. In the former case it may be compared 
to the scrofulous; and in the latter, to the gouty 

Those who are bom to become insane do not 
necessarily spring from insane parents, or from an 
ancestry having any apparent taint of lunacy in the 
blood. But they do receive from their progenitors, 
oftentimes, certain impressions upon their mental 
and moral, as well as upon their physical being, 
which impressions, like iron moulds, fix and shape 
their subsequent destinies. Hysteria in the mother 
may develop the insane diathesis in the child. 
Drunkenness in the father may impel epilepsy, or 
mania, or dementia, in the son. Ungovemed pas- 
sions, from love to hate, from hope to fear, when in- 
dulged in overmuch by the parents, may unloose the 
furies of unrestrained madness in the minds of the 
children. Even untempered religious enthusiasm 


may beget a fanaticism that camiot be restrained 
within the limits of reason. 

As the development of progress is slow and 
gradual, so likewise is the development of degener- 
acy. As men attain high moral and intellectual 
achievements only through the efforts of succeeding 
generations, so it seems but natural that the insane 
should oftentimes trace their sad humiliation and 
utter unfitness for the duties of life back through a 
tedious line of passion unrestrained, of prejudice, 
bigotry, and superstition unbridled, of lust un- 
checked, of intemperance uncontrolled, of avarice 
unmastered, and of nerve resource wasted, ex- 
hausted, and made bankrupt before its time. 

Here are dangers to the human race w^hich potent 
drugs cannot avert. Here are maladies which 
medicines cannot cure. But the medical man, the 
conservator of the public health, realizing the 
dangers which threaten his community or state, 
may help, if he will, to parry those pathological 
blows which the present aims at the future ; and, by 
timely warnings and appeals to his clients of to-day, 
may save them for his own treatment, instead of 
consigning them to an asylum where his own fees 
cease from doubling, and the crazed ones are at rest. 


Now what are the causes, the outward evidences, 
of internal degeneracy, and the best means for the 
prevention of this early beginning, steadily growing, 
far reaching curse which comes only to torment its 
victims with purgatorial tortures before the time ? 

The causes of the insane diathesis are most fre- 
quently traceable to the methods of life of those who 


produce children under such circumstances and con- 
ditions that their offspring bear the indelible birth- 
mark of mental weakness. A cause is found in the 
early dissipations of that father who brings to the 
work of perpetuating his kind only an exhausted 
and enfeebled body, and a demoralized and blas6 
mind. A cause is discovered in the mother who con- 
tributes her mite to earthly immortality, but who 
tarnishes that mite with the dross of her own unholy 
and unhealthy existence. Fast living, such as society 
in many cases seems to demand, is a fruitful cause of 
the mental imperfections so common among the 
rising generation. The sons of royalty, and the sons 
of the rich, are often weak in cerebral force because 
of the high living of their ancestry. Many of the 
high livers of the present day are developing, rapidly 
and surely, strong tendencies to both mental and 
physical disorders. Elbert Hubbard says of those 
who waste their substance upon the Waldorf- 
Astoria air, that they are apt *Ho have gout at one 
end, general paresis at the other, and Bright's dis- 
ease in the middle.'' 

Causes of the insane diathesis are developed from 
the parent's undipped imagination, or sordid desire, 
or base motive, or succession of mean action, or trial 
of fear, or passion of remorse, or undue, gratifica- 
tion of the appetites, or depletion of the bodily sys- 
tem through over-use, or from any perversion of the 
physical, mental, or moral powers. The insane dia- 
thesis is a product of all those forces which tend to 
rack and wreck the minds and bodies of those whose 
lives do not conform to the highest precepts of the 
laws of nature. It is a "genetic evolution" of the 
worse from the bad. 


* ' Cursed be the social wants l^at sin against the strength of youth!' ' 

** Cursed be the sickly forms that err from honest nature's rule ! " 

Not only is the insane diathesis the fruit of wrong 
living and wrong thinking in the early lives of the 
parents, but it is often the result of peculiar states 
in which the reproducing pair find themselves at the 
supreme moment of conception ; and, likewise, in the 
unpleasant emotions induced by the surroundings of 
the mother during pregnancy. Drunkenness, lust, 
rage, fear, mental anxiety, or even incompatibility, 
if admitted to participation in the act of impregna- 
tion, will, each in turn or in combination, often set 
the seal of their presence in the shape of idiocy, im- 
becility, eccentricity, or absolute insanity. The 
famous Diogenes recognized this fact w^hen he re- 
proached one of those half-witted, crack-brained un- 
fortunates, with the remark: "Surely, young man, 
thy father begat thee when he was drunk.'' Burton, 
in his Anatomy of Melancholy, also states that "If 
a drunken man gets a child it will never likely have 
a good brain." And the wise Michelet predicts: 
"Woe unto the children of darkness, the sons of 
drunkenness who were, nine months before their 
birth, an outrage on their mothers." And again: 
" He who is bom of a nocturnal orgy, of the very 
forgetfttlness of love, of a profanation of the beloved 
one, will drag out a sad and troubled life." The 
children of drunkards are often sad and hideous bur- 
lesques upon normal humanity. 

Other unfortunate passions and conditions exert 
as deleterious effect upon the formative process of 
ne\sr human life as drunkenness. As an example we 
give the following authentic case : A father had the 


pkasure of seeing two of his sons grow up strong 
and vigorous, mentally and physically, while a third 
was weak, irresolute, fretful, suspicious, and half 
demented. He confessed to his physicians the cause 
of this family mishap in these words: "In the 
summer of 18 — I failed, owing to my rogue of a 
partner running off with all our money. No man 
perhaps ever felt such a misfortune more keenly than 
I did, and it seemed to me I should never get over 
the shock. I w^as completely unmanned, and feared 
I should go crazy. Well, during this state of things 
my wife conceived, and there is the result. Poor S^! 
He inherits just the state of mind I was then in." 

Scores of such cases might be cited. Such warn- 
ings are neither single nor singular. Such conse- 
quences are the inevitable results of an utter dis- 
regard of the simple and plain requirements of 
nature. A sound body and a cheerful mind can only 
be produced from healthy stock. Those who multi- 
ply, with disease in their bones, care on their minds, 
and canker in their hearts, simply perpetuate and 
intensify their own pains and sorrows and cares. 

Unpleasant influences brought to bear upon the 
mother during the period of pregnancy, are marked 
by a production of a vast variety of mental pecuUari- 
ties. Historical, scientific, and medical works, are 
replete with the untimely records. Rizzio was mur- 
dered in the presence of his paramour, Mary, Queen 
of Scots, she being at that time pregnant with 
James the Sixth. Her son, though a monarch, and 
bom to rule, had a constitutional timidity of tem- 
perament, and a great terror of a drawn sword. 
This was due to the shock of seeing her lover killed 
while she was pregnant. Ishmael practiced the 
insanity of hate because his mother lived with that 


emotion uppermost in her heart while bearing 
within her body the germ of a nation of haters. 
The first Napoleon became a great warrior, and 
cherished the delusion of destiny, because his mother, 
while carrying him in her womb, "exercised queenly 
powers over her spirited charger and the subordi- 
nates of her husband,*' and daily associated with the 
bravest and the best, as well as the most supersti- 
tious, of the French army. 

Those of you who wish to pursue farther the 
study of the laws of heredity, may do so by consult- 
ing the works of Ribot, of Galton, and of Lucas. 

Children bom under the influence of fear are quite 
likely to be troubled with apprehensions of impend- 
ing calamity so intense that they, at last, become 
insane. Mr. P — murdered his wife and nine children. 
Fear pervaded the minds of several pregnant women 
in the neighborhood lest they should meet with a 
similar fate ; and the children bom soon after grew 
up to be crazed by the same emotion that had 
almost paralyzed their feminine progenitors. An 
insane man always manifested the greatest fear of 
being killed, and constantly implored those around 
not to hurt him. His mother had lived with a 
drunken husband who had often threatened to kill 
her, once pursuing her \srith a carving knife. She 
managed to escape, and shortly afterwards gave 
birth to this son, w^ho w^as constantly possessed 
with the pangs of fear, until he finally took his own 
life that he might escape apprehended dangers. 

Not only individuals, but communities, are some- 
times affected by some intense emotion which per- 
vades the minds of all the inhabitants of the country. 
Esquirol remarks that the children bom soon after 
the horrors of the French Revolution turned out to 

^ I 


be weak, irritable, susceptible, and liable to be 
thrown by the least excitement into insanity. The 
same may be said of children bom during the war in 
this country, extending from 1861 to 1865. 

As we have already stated, the insane diathesis 
may be acquired as well as inherited, and by the 
following means : 

1. By imperfect nutrition, 

2. By slight and almost imperceptible injuries to 
the brain — ^blows or falls, 

3. By those fears which are sometimes excited in 
the minds of young children for purpose of govern- 

4. By overtaxing the undeveloped physical 

5. By unwise forcing of the mind in its immature 
or undeveloped stage, 

6. By premature and unnatural excitement of the 
sexual organs of the young, 

7. By suppression of the ambitions, and powers, 
and tastes, and desires, of the enthusiastic ado- 

Insanity is a result of a diseased condition of the 
brain, either ftmctional or organic, and it manifests 
itself most frequently by mental disturbance or dis- 
tress, and by the expression of delusions or halluci- 
nations. It is easy, therefore, to comprehend the 
fact that whatever tends to the weakening of the 
cerebrum, or exhaustion of the central forces of life, 
must necessarily favor the inception and growth of 
insanity. Lack of proper nutrition for the brain is, 
then, a prime cause of acquired mental abnormality. 

As severe blows upon the head produce immediate 
and dangerous diseases of the brain which often 
speedily terminate the lives of those injured, so slight 


blows, quickly forgotten, perhaps, not infrequently 
result in stealthily developed, but none the less dan- 
gerous, conditions, which eventuate in the derange- 
ment of all the mental faculties. There can be no 
law too severe for the punishment of those who 
strike children on the head. If you see a parent or 
teacher boxing the ears of a child, it is your Chris- 
tian duty to secure his arrest and punishment. He 
is guilty of slow murder of the innocents. These 
fiends in human form are the arch-enemies of devel- 
opment and progress. 

As fright to the mother, before her child is bom, 
may produce an unfortunate impression upon the 
offspring, so fright to the young child, occasioned by 
threats of punishment, by locking up in dark rooms, 
or by stories of greedy bears or grinning ghosts, 
produces, oftentimes, a mental shock that makes the 
child wretched in early life, and drives him into 
insanity at a later date. 

As insanity is most prevalent among the working 
classes, and as it frequently succeeds utter exhaus- 
tion of all physical forces, it follows most conclu- 
sively that overwork of the young is a permanent 
cause of gravitation towards lunacy. Our factories, 
shops, and stores, not only produce and display 
artistic and usefal wares, but when the young are 
employed in them, and overtaxed by day and night, 
they become the feeders of hospitals for the insane, 
as well as producers of material for premature 
graves. The regulation by law of the hours during 
which young operators may work, and the legal 
limitations which prevent very young persons from 
working in factories at all, are wise and usefal 
measures for the general w^elfare of the community. 
But the effort in this direction should be continued 


until a proper standard of comfort, and care, and 
fair treatment, has been established in every work- 
ing centre. 

One of the most common causes of acquired ten- 
dency to insanity is the forcing system employed in 
the education of the young. While we believe that 
a proper education and training of the human mind 
is one of the best prophylactics against insanity, we 
hold also that, like all other agencies which, when 
misdirected, become the most terrible instruments of 
evil, the system of popular education, as now prac- 
ticed in many of our schools and colleges, is fraught 
with dangers that are likely, unless checked, to 
destroy the very end it is intended to accomplish. 

Instead of seeking, first, to insure a sound physical 
basis for the mental superstructure, our present 
methods tend to break down physical health, to dry 
up the primal sources of existence, and to bring to 
eventual wreck all the powers of body and of mind. 
These dangers arise not so much from the amount of 
work required, as from the amount of anxiety and 
w^orry which this work induces in the minds of sen- 
sitive children. Many children of the present genera- 
tion are sensitive, with nervous temperaments, and 
they are easily aflfected by the strain of mental toil. 
Such children should be held in check, or guided by 
enlightened intelligence, profound wisdom, and 
ripened judgment, on the part of the teachers. Deli- 
cate children should be kept much in the open air, and 
taught to exercise their muscles until they are fully 
developed physically. The brain of the child should 
lie fallow until general physical strength and 
stamina are insured. Every possible means for de- 
veloping the physical structure to perfection should 
be adopted in the training and education of children 


'whose ancestry has been cultivated and refined over- 
much from a mental standpoint. Especially should 
every child be taught to breathe slowly and deeply, 
and be made to realize the fact that every deep 
breath of pure air drawn into the lungs adds to the 
potency of energy,and the prolongation of life. 

When our public educators come to appreciate the 
sublime fact that the human body and the physical 
brain must be first sufficiently developed and per- 
fected, and that mental growth must be judiciously 
restrained, and that the minds of the young must be 
guided in their early achievements with discriminat- 
ing judgment, then our schools will no longer be 
hot-beds for the propagation of imbecility, nor 
gardens for the cultivation of lunatics. Mental cul- 
ture may accompany physical growth, but always 
in the order of an army following its leader. 

When perfect discipline is attained, and the hour 
for battling with the world arrives, then the mental 
forces of those who are physically strong will cer- 
tainly march to the front, and they will take with 
them the inspirations of health and good blood. 
The truant school boy often makes the most success- 
ful man because he has insisted upon a proper devel- 
opment of his own physical resources, and in this 
w^ay he has acted upon his own responsibility. 

That grand philosopher, Herbert Spencer, refer- 
ring to the evils of intellectual cramming, voices a 
timely warning to both youth and age in these em- 
phatic words: "On old and young the pressure of 
modem life puts a still increasing strain. Go where 
you will, and before long there come under your 
notice cases of children, or youths of either sex, more 
or less injured by undue study. Here, to recover 

from a state of debility thus produced, a year's vaca- 


tion has been found necessary. There you will find 
a chronic congestion of the brain that has already 
lasted many months, and threatens to last much 
longer. Now you hear of a fever that has resulted 
from the over-excitement in some way brought on 
at school. And, again, the instance is that of a 
youth who has already had once to desist from his 
studies, and who, since he has returned to them, is 
frequently taken out of his class in a fainting fit.*' 

And again: **How commonly constitutions are 
thus undermined will be clear to all who, after not- 
ing the frequent ailments of hard-worked profes- 
sional and mercantile men, will reflect on the dis- 
astrous eflFects which undue application must 
produce upon the undeveloped system of the young. 
The young are competent to bear neither as much 
hardship, nor as much physical exertion, nor as 
much mental exertion as the full grown. Judge, 
then, if the ftiU grown so manifestly suffer from the 
excessive mental exertion required of them, how 
great must be the damage which a mental exertion, 
often equally excessive, inflicts upon the young.'' 

A marked case of imperfect nutrition and mental 
overwork resulting in insanity came under my 
notice. The patient, a young ambitious Welshman, 
w^as brought up on a farm where he w^as over- 
worked and indifferently fed. From this hard and 
monotonous life he passed to the severe study and 
indoor confinement necessary to preparation for col- 
lege. Though slight in form and weak in body, he 
succeeded in his new work remarkably well, and 
was a leader in intellectual achievements at the 
academy in his native village. After graduating 
from the academy he entered college, but only to 
breakdown under the unnatural strain; and in a few 


weeks he passed from the quiet shades of learning to 
the shadier refuge of an insane asylum. The diathe- 
sis in this case was acquired by the means men- 
tioned, for there is no history of hereditary taint, 
and no other causes for insanity to be found. Such 
a case illustrates both the unwisdom of the victim 
for pursuing such a suicidal course, and the folly of 
his parents in permitting it to be entered upon by 
the son. It should also serve as a warning to those 
who are yet free from the distressing toils of unwise 
scholarly ambition. 

In addition to the dangers of excessive mental 
strain which beset the young in our present hot-beds 
of learning, we find a leading and growing tendency 
to excess in social pleasures. We find that the days 
are passed in exhausting study, and the nights given 
over to unrestrained social enjoyments. Business 
and pleasure should always find a happy and 
harmonious combination in our daily lives, but the 
amount of each should be very much reduced in the 
daily round of the average young American. Ex- 
cessive athletic sports are likewise dangerous, and 
produce disastrous consequences upon both the 
heart and the brain. 

Children in schools are not only sometimes over- 
worked, but in some boarding schools they are also 
very apt to be underfed. Hurried and imperfect feed- 
ing on the part of the young should be scrupulously 
avoided. While you may live happily on very plain 
and inexpensive food, it should always be carefully 
and properly cooked. You should secure good, plain, 
w^holesome fare in abundance, if you would succeed 
as a student. My advice to every young man or 
woman is to keep his or her stomach full of good 
nourishing food, and to acquire an education at a 


slow but systematic pace. Eat apples, oranges, oat- 
meal porridge, cracked wheat mush, graham bread, 
fresh eggs, peas and beans, salads and olive oil, and 
but little meat. The ancients lived to be one hun- 
dred and twenty years old with eyes undimmed, and 
they ate and drank and flourished on **com, wine, 
and oil.*' 

Another cause of the insane diathesis lies in pre- 
mature, improper, and unnatural use of the sexual 
organs. Many of the hospitals for the insane pre- 
sent histories and marks of this unfortunate habit. 
Every unnatural use and over-excitement of the 
sexual organism tends not only to epilepsy, but to 
imbecility, mania, and dementia. The young should 
be taught to avoid masturbation because it is a 
source of much mental weakness and abnormality. 

Again, the suppression of ambition, or taste, or 
desire, leads to disappointment and mental depres- 
sion in the young. A boy may wish to enter one of 
the learned professions, or to take up some mercan- 
tile pursuit, but through the force of circumstances 
he may be obliged to engage in some menial toil, 
and thus a laudable ambition is sacrificed to neces- 
sity. A girl may have a taste for music or painting, 
but the binding and repressing force of poverty may 
prevent the gratification of such a taste, and this 
may lead to bitter disappointment and depression 
of all the mental faculties. The repression of a 
natural desire may impel its victim to drift into the 
slough of despond. These subtle causes of mental 
disorder should be carefiiUy considered, and every 
commendable impulse of the young should be grati- 
fied so far as possible, in order to avoid the pitfall of 
insanity. There is no country in the world where 
the possibility of rising to eminence, to fame, and to 


fortune is so broad, so bright, and so encouraging as 
in this favored land. And yet there is no country in 
the world more replete with broken wrecks of disap- 
pointed ambition than this. We meet such wrecks 
in every street and thoroughfare of the great cities, 
and along the highways and byways of the country. 
They flock about the tables of the money changers in 
Wall street ; and they hover, like flies, in the neigh- 
borhood of every office or position of honor, politi- 
cal or otherwise, throughout the length and breadth 
of the several states. When the means used for the 
gratification of man's ambition fail, when hope de- 
ferred has made the heart sick, then there creeps in a 
mental state and a physical condition which favor 
most strongly the production and the ripening of 
insanity. A reasonable ambition is necessary for the 
accomplishment of every noble task, but that ambi- 
tion is unwise and unholy, when, under its effiects, the 
young break down and wear out prematurely, and 
when under its sweeping shock they become dis- 
gruntled wrecks which even the gentle ministrations 
of an insane asylum cannot possibly repair. Moder- 
ate ambition will lead to ripe achievement ; excessive 
ambition is worse than the battle path of glory, for 
it "leads but to the grave *' direct, while the former 
drags its victims through years of weary suffering 
before the rest of the tomb is vouchsafed to their 
tired bones. 

Now the question arises : What are the outward 
evidences of the insane diathesis ? They are numer- 
ous and complicated. They present themselves in 
every varying shade of imperfect physical develop- 
ment, in endless varieties of cranial contour, and in 
numerous types of facial expression. To understand 
them most fully, let us present an historical model of 


a well-balanced brain, and contrast it with the ap- 
pearance of one whose tendency is to mental 

Every one recognizes a healthy constitution and 
rare mental equipose when the name of the illustri- 
ous Washington is mentioned. No one ever sus- 
pected the Father of his Country of leanings toward 
insanity. What regularity invested his every feat- 
ure ! What benevolence and good sense characterized 
and tempered his expressions ! He had passions like 
unto other men ; but he likewise possessed wonderful 
powers of self-control. Undisturbed amid the whirl- 
ing storms of popular excitement, Washington with- 
stood many shocks before which weaker men would 
have been swept into the pitfall of insanity. Few 
men are further removed from inclination to mad- 
ness than was the immortal Washington. 

Contrast the brain symmetry of such a man with 
the uncanny shapes and illogical action of onew^hose 
bent is ever toward that which is incongruous and 
intellectually dicrotic. Picture the benign features 
of the first President, and again behold in the de- 
scription of Dickens the distorted countenance of a 
Quilp, chattering vengeance against those around 
him. Contrast the beaming expression of him who 
w^as first in his countryman's hearts with that 
wretched Barnaby Rudge of whom the master of 
novelists writes : **Hewas about three and twenty 
years old, and though rather spare, of fair height 
and strongly made. His hair, of vsrhich he had a 
great profusion, hung about his face and shoulders, 
and gave his restless looks an expression quite un- 
earthly — enhanced by the paleness of his complexion. 
* * * * Startling as his aspect was, there was 
something plaintive in his wan and haggard looks. 


For the absence of the soul is far more terrible in a 
living- man than in a dead one ; and in this unfortu- 
nate being its noblest powers were wanting. In his 
face there was wildness and vacancy/' 

Had Dickens better understood the mysteries of 
psychology, he would not have claimed that the soul 
was absent, but that it found but a faint expression 
through the unfortunate medium of a soggy and 
misshapen brain. 

In the faces of those whose diathesis is that of a 
sickly mentality, there are always the marks of dis- 
order and desolation. Their **dome of thought*' is 
but a dilapidated ** mansard," and the windows of 
their souls are darkened from within by an unseemly 
and non-protective armament against approaching 

The heads of those who are bom or bred to 
insanity are almost always misshapen. One side is 
fttUer than the other ; one ear is set higher than the 
other; the eyes peer forth in a restless uncertain way 
from beneath beetling brows ; the nose slants slightly 
across the face ; the mouth has an uneven cut, and 
the lips match each other but poorly. 

There are also in such persons a great variety of 
expression — the sinister, the ugly, the mock-sober, 
the leering, the vacillating, the tricky. There may 
be developed, unmistakably, in the features of the 
prospective lunatic the malice of the mule, the cun- 
ning of the fox, the grinning fiendishness of the 
hyena, or the sedate sottishness of swine. All these 
external marks and appearances are but the mir- 
rored images of distorted minds. Inherent crooked- 
ness is thus oftentimes forcibly displayed, and the 
tendencies of the inner man to wallow in the mire of 
mental ruin are ever thus revealed. 


Are there means for avoiding the development 
and growth of the insane diathesis? Are there 
means for the cure or relief of transmitted or ac- 
quired mental defects ? Here are questions which the 
generations of the past have left unanswered. Yet 
the solution of such problems may, I believe, be ac- 

To avoid the evils liable to arise from the propa- 
gation of the insane diathesis, the parties to the 
crime must pause and study the new philosophy of 
life — a philosophy which shall guide them to the ac- 
complishment of good and noble results, rather than 
to those which are ignoble and demoralizing to 
humanity. The avoidance of debasing passion ; the 
putting away of that cup whose contents is adder's 
juice ; the shunning of all unnecessary anxiety and 
cares of life, and in their stead the patient cultiva- 
tion of all higher virtues and better tempers, will, at 
last, insure an offspring that will not only bless their 
ancestry, but will fill the earth with happiness, and 
health, and contentment of mind and spirit. 

"Like begets like'' though with increasing or de- 
creasing intensity not only in physical contour, but 
in mental symmetry or mental idiosyncrasy; and 
not only are the general thoughts and emotions of 
the parents impressed upon their children, but even 
the flitting passion of a moment may cast a cloud of 
darkness over an entire life, just as the silvered 
sheet of the photographer receives a fadeless impres- 
sion from a transient ray of sunlight. The mind of 
the unborn, like the cylinder that revolves in the 
phonograph, may receive impressions of happy or 
unholy thoughts, and reproduce them with faithful 
accuracy in the years to come ; aye ! even when the 
brain of the mother is but dust, and her heart no 


longer responds to any emotion, and her guiding 
hand is palsied by the chilling touch of death. 

To that "holy of holies" then, the sacred temple 
of procreation, should be brought only such oflFer- 
ings as are sure to prove acceptable to the Lord of 
Nature. While the mother bears within her being 
the helpless new life, there should surround her a 
magic presence of benign and stimulating influences, 
from which influences the coming mind may draw 
inspirations that shall feed and nourish and develop 
all its forces to a symmetrical perfection. 

When once the human being has appeared upon 
the carpet of life, then the practical work of develop* 
ment and growth should begin. The great end 
should now be to remedy, as far as possible, all in- 
herent defects, and to promote the growth of all 
possible virtues and powers. The child should be 
watched over,- and guided, and guarded with the 
same jealous care that was, or ought to have been,, 
exercised toward the mother during the sacred 
term of pregnancy. If proper care is taken, the 
ungainly in body and the weak in mind may develop 
both symmetry and usefulness. Even in the worse 
types of mental disease there are some salient and 
bright spots upon which good influences may act : 

** There is some soul of goodness in things evil, 
Would men observingly distil it out.'* 

Bright surroundings, pleasant associations, stim- 
ulating encouragements, abundant food of the best 
and plainest quality, fresh air, active exercise, in 
the clear sunlight, together with simple direction 
not forcing of the mental faculties, will in the course 
of patient time produce from even poor stock such a 
robust and cultured race as to be the astonishment 
of those who iumish and mold the material. 


In making these marches to higher and better 
things, we may, I think, be permitted to state that 
homoeopathy has already done much, and will do 
more, with the medicines at her command. Medi- 
cine may not only cure active disease, but, if properly 
applied, it may act as a stimulus in the growth and 
development of the human body. Such remedies as 
Calcarea Carbonica, and Hepar Sulphur, and Graph- 
ites, and Phosphorus, and Sepia, and Silicea, and 
Sulphur, have here a field of action surpassing any in 
which they have heretofore wrought. The "tissue 
remedies,'' so-called, are, we believe, destined to win 
triumphs in this new arena, which shall transcend 
all the glories of medical achievement in the past. 
God hasten the day when we may learn how to 
wield aright these mighty weapons against fatefiil 
heredity and acquired degeneracy ! 

In conclusion, we offer another warning and an- 
other injunction to the young, to the efiect that not 
only must the mental powers be protected from pre- 
mature exhaustion by overwork, but they must also 
be fortified against the too common dissipations of 
youth, and sustained by the recuperative influences 
of timely and abundant sleep. It is natural to be 
spendthrift of those gifts which have been lavishly 
bestowed upon us, and of which we seem to have an 
exhaustless supply. Hence we waste our youthful 
vigor, amid scenes of exciting folly, not only by day, 
but through the long-drawn and precious hours of 
the night — ^hours that are precious because of their 
designed purpose to replenish and restore the inevi- 
table wastes of life. Through moderation alone are 
happiness and health long-conserved. The midnight 
lamp of the worker, and the midnight lamp of the 
pleasure seeker, alike consume with undue avidity 


the cruse of oil allotted to each one's life. Therefore 
the lamp must be put out early if the owner would 
live long and well in the land. 

Not only must excessive waste be shunned, but 
restoration and repair must be steadily and perse- 
veringly attained. The sin of omission is quite as 
heinous as the sin of commission. To neglect the 
maintenance of one's powers, in their fullest possible 
measure, is as deplorable and wrong as the throw- 
ing away of strength already acquired. 

The precepts embodied in such experiences and 
such teachings as we have endeavored to trace in 
this lecture are, we believe, sound and practical. If 
the medical profession would rise to the duty of 
properly warning both the young and their natural 
guardians, and if these would give heed to such 
warnings, then the incomputable evils of premature 
forcing of the brain would be averted ; the folly of 
dissipation would be shunned, the necessity for 
ceaseless repair would be recognized, and the sources 
of mental unsoundness, now burdened with a 
tropical luxuriousness, would become barren and un- 
productive as the sullen shores of the dark Dead Sea. 




To-day we shall seek to discuss the nature and 
quality of sleep — Sleep, "the twin sister of Death." 
We shall also portray the necessity for sleep, and 
nature's method for securing it. Again, we shall 
consider the causes of sleeplessness ; and finally, we 
shall endeavor to point out the safest and surest 
dietetic, medical, and other means for the cure or re- 
lief of insomnia. 

Some of you have already learned that sleepless- 
ness is one of the prime and leading indications of 
approaching insanity. Still, there are many excep- 
tional cases of insomnia which do not terminate in 
mental unsoundness. But insomnia is so often the 
forerunnner of mental disorder, that it seems proper 
to devote one lecture of the course on mental dis- 
orders to a consideration of sleep and sleeplessness. 

Probably no writer in ancient or modem times 
has so fully discussed the subjects of somnia and in-, 
somnia as the immortal Shakespeare. Hence, when 
w^e would know of sleep and sleeplessness — of the 
beneficial eflfects of the one, and the distressing qual- 
ities of the other, we naturally turn for information 
to the luminous pages of the most wonderful poly- 
chrest thinker that the world has ever produced. 
When we go back to the days of the Bard of Avon, 
we find firom him who "held the mirror up to 


nature'* that many a time and oft the "fiing'd 
curtains of his eyes were all the night undrawn." 
Shakespeare recorded his own experience as well as 
that of the men and women who lived in his time. 

The sleep of age and of youth is described when 
Friar Laurence says : 

*' Care keeps his watch in every old man's eye, 
And where care lodges, sleep can never lie ; 
But where nnbruised youth with unstuff 'd brain 
Doth couch his limbs, there golden sleep doth reign.** 

The tranquillity of sleep is outlined here : 

** And to conclude, the shepherd's homely curds, 
His cold thin drink out of his leather bottle. 
His wonted sleep under a fresh tree's shade. 
All which secure and sweetly he enjoys. 
Are far beyond a prince's delicates." 

Worry is one of the great causes of sleeplessness : 

" O polish'd perturbation ! Golden care ! 
That keep'st the ports of slumber open wide 
To many a watchful night ! Sleep with it now ! 
Yet not so sound, and half so deeply sweet. 
As he, whose brow with homely biggin bound. 
Snores out the walch of night." 

The .best cause of sleep is honestly acquired 
fatigue from active exercise : 

** Weariness 
Can snore upon the flint ; when restive sloth 
Finds the down pillow hard." 

The tired boy sleeps better than the monarch : 

'* Canst thou, O partial Sleep, give thy repose 
To the wet sea boy in an hour so rude. 
And in the calmest and most stillest night, 
with all appliances and means to boot. 
Deny it to a King? Then, happy low, lie down ! 
Uneasy lies the head that wears a crown." 


The golden qualities of sleep are such as to be- 
come blessings and benisons from friends to friends : 

*' Sleep, Richmond, sleep in peace and wake in joy. 
Thou quiet soul, sleep thou a quiet sleep.** 

This was Romeo's invocation to Juliet : 

** Sleep dwell upon thine eyes ; peace in thy breast.*' 

The goodness of Lady Mortimer is set forth when 
the poet declares : 

*' She will sing the song that pleaseth thee, 
And on thy eyelids crown the god of sleep.** 

Titania to her lover says : 

*' 1*11 give thee fairies to attend on thee. 
And they shall fetch thee jewels from the deep, 
And sing, while thou on pressed flowers dost sleep.** 

In behalf of fallen heroes, Titus said : 

** There greet in silence, as the dead are wont. 
And sleep in peace, slain in your country's wars.** 

Also the poet declares that in that land of the 
blest there 

** Are no storms. 
No noise, but silence and eternal sleep." 

A lack of sleep is the most horrible of earthly 
terrors : 

** No sleep close up that deadly eye of thine, 
Unless it be while some tormenting dream 
Affrights thee with a hell of ugly devils. 

** Sleep shall neither night nor day 
Hang upon his pent-house lid ; 
He shall live a man forbid. 

* ' Not poppy nor mandragora, 
Nor all the drowsy syrups of the world. 
Shall ever medicine thee to that sweet sleep 
Which thou own'dst yesterday.** 


The blessings of sleep, on the other hand, are 
further outlined as foUow^s : 

" With him above 
To ratify our work, we may again 
Give to our tables meat, sleep to our nights.*' 

** How sweet the moonlight sleeps upon that bank." 

*• The best of rest is sleep." 

** Our little lives are rounded with a sleep.** 

These quotations from the dramas and tragedies 
of Shakespeare, illustrate the fact that history re- 
peats itself, and that the experiences of humanity 
are much the same through all the centuries. 

Sleep is a prime and urgent necessity of our 
natures. To secure it in abundance, with system 
and regularity, is the aim of the philosopher, the 
dream of the poet, and the easy accomplishment of 
the workingman. The natural conclusion is that we 
should all utilize a portion of our time by building 
railroads, or by digging canals, or, like Gladstone, 
by chopping down trees. 

What is sleep ? We are told that *' it consists of a 
temporary suspension of the fttnctions of the cere- 
bral portions of the nervous system.'' Sleep is the 
act of closing the doors of the brain against external 
intrusion while the process of rest and repair is 
going on within. 

The process by which sleep is induced is that of a 
moderate anemia, or lessened blood supply to the 
brain. This anemia, while sufficient to quiet the 
ordinary operations of the mind, is not far enough 
advanced to restrict the processes of repair in the 
brain. The theory of cerebral anemia during sleep is 
supported by the experiments of Alexander Fleming, 


i:he investigations of Durham, and the observations 
of the state of the retina during sleep with the 
ophthalmoscope by Hughlings-Jackson. Fleming 
tried compression of the carotid arteries, and suc- 
-ceeded in causing sleep. Durham removed the skuU- 
<:ap from dogs, and noted that in these animals, 
when asleep, the brain was always anemic. Hugh- 
lings-Jackson found that the expansions of the optic 
nerve are paler and less congested during sleep than 
^t other times. 

Not only is the brain less fully supplied with 
blood during sleep, that is, not only is the volume 
^decreased, but the velocity with which it flows is 
likewise diminished. The heart's action is slower 
and less active during sleep than during wakefulness. 

A hyperemic condition of the brain stimulates the 
greatest mental activity, unless the hjrperemia 
passes to a state of over-powering congestion, while 
the anemic state promotes rest and repair. The 
-condition for sleep is that of cerebral anemia. 

Now what are some of the natural causes of 
sleep? What are the causes which prevent sleep, 
and by what means shall the latter be removed? 
The favoring causes of sleep are the darkness of 
night, the removal of all disturbing agencies, the 
horizontal position of the body, an easy and com- 
fortable bed, cessation from toil and thought, a 
sufficient nourishment to satisfy the demands of the 
-entire system, and a release of the brain from sen- 
sorial impressions. 

Under these favoring causes the approach of sleep 
is usually swift and easy. It is said that the mind 
is *' pervaded by a strange confusion which amounts 
almost to a mild delirium; the ideas dissolve their 
•connection with the mind one by one, and its own 


essence becomes so vague and diluted that it melts 
away in the nothingness of slumber." 

Health of body and peace of mind are the normal 
conducements to sleep. Hence we find that the 
young, the innocent, the healthy, and the happy are 
the best and most natural sleepers. 

Among the assisting causes of sleep, we may 
name monotonous sounds, such as slow music, the 
humming of bees, the falling of rain, the rattle of 
wagons, the roll of street cars, the roar of water- 
falls, the splash of the ocean surf, and, most of all, 
the voice of a dull preacher who, armed with a 
soporific sermon, seems to have no other aim except 
to put to sleep both the pillars and the gods! 
Monotonous sounds attract the attention of the 
mind from inward cares or outward irritation, and 
lull the senses to narcotic forgetfulness, like the 
crooning voice of a motherly old nurse. 

We may also note, as a sleep producer, the effect 
of cold upon the system, which promotes, at first, 
drowsiness, and sometimes an irresistible tendency 
to sleep. And again, excessive heat tends to indolent 
inactivity of the body, drowsiness of the mind, and 
an inclination to doze and slumber. Alcohol, opium, 
and other drugs are often sleep-compelling when 
given in overmastering doses. A lymphatic tempera- 
ment favors likewise the induction of sleep. 

Now in considering the causes which prevent 
sleep, we name : 

1. Those pathological conditions of the brain 
which derange the normal action of the mind. Chief 
among these are hyperemia, or excessive blood sup- 
ply, on the one hand, and excessive anemia, or lack 
of supply, on the other. 

2. Protracted overuse of the brain— that is, over- 



work until the strain produces, or tends to produce, 
vasomotor paralysis. 

3. Worry. Worry is an undue anxiety over the 
common or little every-day affairs of life. It is this 
everlasting worry that produces more than three- 
fourths of all the mental disasters which befall the 
children of men. My advice to you is to clean out the 
sand of worry from the bearings of your existence, 
and pour in the oil of peaceful contentment with 
your lot. Then you will run the race of life easily, 
without danger of friction, or overwear, or hinder- 
ing hot-boxes on the baggage car of your brain. 
You may work and study with great vigor during 
the day, and no harm may result ; but when worry 
finds its way into every recess of reason, when it 
breaks the back of our better judgment, and stuns 
our wills, then our brains lose their best powers, and 
our trains of thought fall into abject and hopeless 

4. The natural temperament of some people is a 
formidable obstacle to the acquirement of sleep. 
Bilious people are apt to be melancholy. The 
nervous temperament impels its owner to rapid 
action, until exhaustion, irritability, and sleepless- 
ness follow. Victims of an unfortunate temperament 
seek matrimonial alliances with those who are 
directly their opposites. The despairing and the 
despondent should consort with the sunny and the 
sanguine, while the irritable and excitable should 
secure, if possible, mates who are lymphatic and 

5. Localized disease in some portion of the body, 
other than the brain, may, by reflex action, produce 
sleeplessness. Thus we may have disease of the 
heart, which induces wakefulness. The lungs, the 


stomach, the liver, the bowels, or the genital organs 
may all become, through disease and by reflex ac- 
tion, centers of sleep disturbing tendencies. To cure 
sleeplessness under such circumstances requires a 
cure of the organs involved. 

We now offer a few practical suggestions for the 
induction of satisfactory sleep: 

1. We should cherish, so far as possible, a philo- 
sophical frame of mind. That is, we should "take 
no thought for the morrow." You should impress 
this philosophy upon your sleepless patients. 

2. To secure sleep we must put the body in proper 
condition, and this end is attained by proper toil or 
exercise, by suitable diet, by careful attention to all 
the excretory organs, and by polishing up the 
human temple along the line suggested by the old 
adage: "Cleanliness is next to godliness." He who 
works and washes wisely and well rarely fails to 
attain good sleep at night. Before retiring to sleep 
the bladder and the bowels should be relieved ol 
their contents, if necessary, otherwise they act as 
localized irritants which, by reflex influence, disturb 

3. Proper nourishment of the body is essential to 
the acquirement of sleep. If the brain is weak and 
anemic — that is, below the health level — it must be 
strengthened and nourished by appropriate nutri- 
ment before good sleep can be attained. Thus it 
happens that a weakly person is often made to sleep 
well by drinking considerable quantities of hot milk, 
or beef tea, or some mildly stimulating broth, or 
soothing gruel, a short time before the hour for sleep 
arrives. The hung^ nerves having been satisfied, 
sleep comes easily. On the other hand, if there is a 
tendency to hyperemia of the brain, and an over- 


active state of the mind, benefit is often derived from 
partaking of a little plain solid food just before retir- 
ing. While the stomach is busy digesting this solid 
food, the brain may be relieved of engorgement to 
such an extent as to admit the inception of sleep. 
As a rule, in this climate, it is neither safe nor health- 
fill to go to bed on an empty stomach. Of course if 
a person is a dyspeptic, and subject to much pain 
during the process of digestion, care should be exer- 
cised as to the variety and quality of the food con- 
sumed. Individual idiosyncrasies should be con- 
sidered, and that food should be selected which 
experience has shown to be the most agreeable and 
satisfying. Try to find for each individual case the 
food which most surely agrees, and try to keep your 
patients away from that food which disagrees. 
Sometimes if the stomach is very weak, and the 
mind also, a little good old wine may be taken with 
the food the last thing at night. Sometimes brandy 
has a marked influence in the relief of insomnia. 
Some years ago we had a woman patient who had 
suffered with intense insomnia for years. We tried 
various remedies without success. At length we 
gave her from two to four ounces of brandy each 
night on going to bed. The patient began to sleep 
regularly and suflSciently, and in three months the 
insomnia of years had entirely passed away. The 
patient slept well, ate well, and became strong and 
cheerful. As soon as the natural tendency to sleep 
was restored, the brandy was stopped, but good 
health and abundant sleep continued. 

4. A warm bath, followed by a cold douche and 
brisk rubbing, will oftentimes produce drowsiness 
and ability to sleep by those who have been pressed 
with cares, and who have been irritated or disturbed 


during the day in body and mind. Business men 
who are shut up in close offices all day, and who 
work very hard with their brains, may be greatly 
relieved by a quick hot and cold bath, followed by a 
brisk rubbing, just before going to bed. The rubbing 
should be performed by an attendant, in order to 
avoid causing extra fatigue to the patient. 

5. Fresh air should be supplied freely in every 
sleeping-room, yet the sleeper should be protected 
from even moderate draughts ; for these, if long-con- 
tinued, will produce chilliness of one portion of the 
body, while another portion may be over-heated, 
and thus a disturbing inequality of circulation 

6. Beds should be firm in texture, level, and well- 
elevated from the floor ; for thus the sleeper is above 
dangerous, heavy gases. Some think it is wise to 
have the head toward the north and the feet toward 
the south, in order that the magnetic currents may 
affect the system favorably. Bed clothing should be 
light and porous as practicable. Soft woolen 
blankets are best. Stiffly starched counterpanes are 
objectionable, and should be removed at night, be- 
cause they do not favor good ventilation. 

7. The position of the head is of importance dur- 
ing sleep. In cases of hyperemia the head and 
shoulders should be well elevated by means of large 
pillow^s. In cases of anemia, w^here the heart's 
action is weak, and the blood supply is imperfect, a 
very slight elevation should be granted. One small 
pillow is generally enough for anemic patients. 

8. Another means for inducing sleep is massage, 
or muscular manipulation. This should be applied 
by a trained nurse, and according to systematic 
rules, as laid down by the attending physician. If 


you want to learn more about massage, read Dr. S. 
Wier MitchelPs interesting work, entitled "Fat and 

We come now to the use of remedies for sleepless- 
ness, and by way of episode we will give you a few 
ancient prescriptions for the production of sleep. 
Lemnius advises that you anoint your temples with 
virgin wax at the hour of sleep. Mizaldus tells us 
to rub our weary and sleepless brows with rose 
water and vinegar, together with an ointment made 
of nutmegs grated upon rose cake, and this to be 
wet with a little woman's milk. Cardan suggests 
that we smear our teeth at bed-time with ear wax 
from a dog. To these may be added oil of nenuphar, 
wormwood, mandrake, pillows of roses, fat of a 
dormouse, swine's gall, hare's ears, violet leaves, 
lovage waters, and lac virginale. It seems to me 
that the application of these remedies should be left 
to the tastes of the patient ! 

An ancient and likewise a modern and very valu- 
able remedy for sleeplessness is the common lettuce 
which grows in every garden. You remember that 
Venus, after the death of Adonis, her lover, threw 
herself upon a bed of lettuce in the back yard, and 
thus gained sleep and forgetftilness of her sorrow. 
Galen, one of the fathers of medicine, relates that his 
own sleeplessness was relieved by eating lettuce 
salad at night. 

Upon the principle that a physician, especially a 
homoeopathic physician (who is a physician plus a 
homoeopath), cannot know too much, we present a 
brief list of old school hypnotics, w^ith the doses, and 
the authority for their use : 




Drug Dose Authority 

Bromide of Potash, 5 grs. to i dr., S. O. L. Potter 

Bromide of Soda, 5 grs. to i dr.. 

Bromide of Calcium, 5 grs. to i dr., 

Bromidia, i fl. dr. in water, Battle & Co. , St. Louis 

Chloral, 2 to 30 or more grs.. Potter 

Codeine, ^thto i gr., S. O. L. Potter, Brannan 

Bromal Hydrate, i to 3 grs. , at bed-time. Dr. Steinauer 

Hyoscinae Hydrobromas, yiiyth to ^^^th gr.. Potter & Dr. Lyon 
Monobromide of Camphor, i to to grs. in emulsion. Potter 
Morphine, ^^th to >^ gr. , 

Opium, powder, %\}Ci to 2 grs.. 

Opium, tincture, 2 minims to 22 drops — i gr. opium, 
Paraldehyde, 30 minims to i dr., Potter & Granger 

Sulfonal, 15 grs., repeated 2 to 5 hours. Granger, Seguin & Brannan 
Trional, 15 to 30 grs., Henry Morris, M. D. 

Probably Sulfonal is one of the most commonly 
used, and perhaps one of the least harmful hypnotics 
in general use among our old school brethren of to- 
day. It is well to know something of these hyp- 
notics, because you may be called upon to treat 
patients who have been heavily dosed with them, 
and you should know what to expect, and how to 
antidote the effects of such drugs. In our treatment 
of more than five thousand insane persons, many of 
whom have suffered with insomnia, we have never 
felt obliged to use old school remedies in old school 

We now give a list of homeopathic remedies, 
together with the officinal doses, as prescribed for 
their physiological effects : 

Drug Dose Authority 

Avena Sativa, 5 to 30 drops, Q Dr. Trowbridge 

Belladonna, i to 30 drops, Q Dr. Potter 

Cannabis Indica, 5 minims to i dr., Q ** 

Cimicifuga, 15 minims to i dr., Q ** 

Coca, >^ to I dr., fluid extract, '* 







lo to 50 drops, 


Dr. Potter 


10 drops to I dr. 




2 dr. to I oz., 



Kali Bromide, 

5 grs. to I dr., 



10 grs. med. dose, 

U. S. Dispensatory 

Nux Vomica, 

I to 5 or 10 minims, 

Dr. Potter 


30 to 40 drops. 


Boericke & Tafel 


5 minims to % dr., 


Dr. Potter 


>^ to 2 dr.. 


Zincum Met., 

IX to 3x, 

Dr. Hughes 

We come now to present, as a climax, the charac- 
teristic indications for a few of the most prominent 
homoeopathic remedies for sleeplessness. These rem- 
edies have been proved, and their symptoms have 
been duly recorded. We prescribe them in accord- 
ance with the ** totality of symptoms,'* and accord- 
ing to the methods laid down by Samuel Hahne- 
mann. The application of these homoeopathic 
remedies affords, we believe, the best results in the 
long run, and they leave the patient at the end of a 
course of treatment without injury or damage. We 
give drop doses once in from one to four hours, 
according to the severity of the symptoms ; and we 
use the third, sixth, twelfth, and higher potencies. 
Sometimes we begin with the third decimal, and 
sometimes with the third centesimal, and go up 

Aconite. — Sleeplessness after exposure to cold 
winds, and where there is a fall, strong, quick pulse, 
with great restlessness, anxiety, and fear of death. 
It may be used in mental anxiety caused by the 
shock of bad news. (Also Gelsemium, Ignatia, and 
Opium). Cases of acute melancholia with agitation, 
or acute mania with great excitability, are often 
relieved at the outset by the use of Aconite. 


Belladonna, — Sleeplessness, with flushed face, 
dilated pupils, and throbbing in the head. The 
patient has horrible dreams, from which he awakens 
in a fright, but he soon overcomes this fright, and 
becomes hot and pugilistic. 

Cbamomilla, — Sleeplessness on account of severe 
pain, such as toothache. The patient is cross and 
irritable, and inclined to groan and move about. 
Chamomilla is both ugly and contemptible. 

Cimicifuga {Actea Racemosa). — Sleeplessness after 
drinking, opium eating, and great muscular exer- 
tion ; after protracted watching, where there is rest- 
lessness, and great tremulousness of the muscles 
throughout the entire system. Pain in the base of 
the brain, extending to neck and shoulders. The 
mind is wrapped in the blackness of eternal dark- 
ness. (Some prefer the alkaloid, Macrotin for 
drunkards and opium eaters. As an antidote to the 
opium habit, give Macrotin in the third decimal trit- 
uration, a two-grain powder every three hours). 

Coffea, — Sleeplessness from excessive mental ac- 
tivity. Excessive sensitiveness to all impressions; 
fidgety, and cannot compose the mind to sleep. It is 
best to give Coffea in the sixth or the thirtieth 

Gelsemium. — Sleeplessness from nervous irrita- 
tion, or acute disorders of the nervous system. The 
patient is dull and stupid, but unable to sleep. Gel- 
semium is often useful in the sleeplessness of acute 
alcoholics. Drop doses of the second or third decimal 
is frequently effective, although sometimes the tinct- 
ure is administered in two or three drop doses. You 
may give Gelsemium for acute drunks, for long 
drunks Nux Vomica and Cimicifuga, and for very 
long drunks Opium; and when the drunk has con- 


tinned until great exhaustion, emaciation, and rest- 
lessness follow, then give Arsenicum. 

Hyoscyatnus, — Sleeplessness without apparent 
cause. The patient is very nervous; jumps in his 
sleep, and thus awakens himself. While the Hyoscy- 
amus patient cannot sleep, he is nevertheless good- 
natured and jolly, although inclined to talk upon 
salacious subjects, and to uncover the body. Women 
especially when needing Hyoscyamus take off their 
clothes because they are erotic. The difference be- 
tween erotomania and nymphomania is this : Eroto- 
mania has great mental excitement upon sexual 
subjects; nymphomania has intense physical desire 
for sexual intercourse. Both are affected in body 
and mind, but in the Hyoscyamus case the mental 
symptoms predominate, while in the physical case 
Cantharis is called for. Where the patient awakens 
many times during the night, but falls asleep easily, 
give Phosphorus. Hyoscyamus has a jolly delirium, 
Nux Vomica has an intense crossness and irritability, 
while Phosphorus is sad and solemn. 

Kali Bromidum. — This is a valuable remedy for 
insomnia where it is induced by the exhaustions and 
irritations of long-continued disease. Large doses ot 
this drug are unnecessary. We use the first decimal 
trituration, giving a one or tw^o-grain dose every 
hour during the evening, say, from six to eleven 
o'clock. It is very effective in the sleeplessness ot 
sick and wasted women. 

Nux Vomica, — This is suitable for those who sleep 
during the middle of the night, but awaken about 
three in the morning. Such cases are usually hard 
workers, and perhaps hard drinkers. Sometimes 
they are studious and sad, and sometimes they are 
lazy, as well as irritable. The Nux Vomica patient 



rarely comes out of his sullen mood, except to make 
trouble for others. 

Stramonium, — ^The Stramonium patient is sleep- 
less because he has horrible hallucinations of sight. 
He sees all kinds of strange animals coming toward 
him from every direction, and these apparitions pro- 
duce in his mind a horrible, abject, and cowardly 
fear which prevents sleep. Stramonium is often 
called for in the sleeplessness of acute mania and 
acute alcoholism. 

Veratrum Album. — This is a remedy which assists 
in the induction of sleep where the patient is suffer- 
ing with acute mania, or puerperal mania, or relig- 
ious excitement. There is great restlessness of the 
mind, with pallor of the countenance, coldness of the 
body, and tendency to collapse of all the vital forces. 
The patient may be full of religious supplication, or 
may dream of robbers, or of being bitten by a dog, 
or of being drowned. 

There are a few new remedies for sleeplessness 
which are sometimes valuable, and generally harm- 
less. Avena Sativa (the common oat) is useful for 
the sleeplessness of those who are over-worn by hard 
work until they cannot sleep. The usual dose is 
fifteen or twenty drops of Avena tincture taken at 
bed-time. Coca Erythroxylon is sometimes used in 
neurasthenic, neuralgic, and hysterical cases. Pisidia 
(the Jamaica dogwood) is another remedy which 
may be used in behalf of weak, exhausted and sleep- 
less patients. It is sometimes useful in the early 
stage of acute mania. Passiflora Incarnata is a 
remedy which has been used with success in the 
sleeplessness of women who are suffering with great 
stress of excitement, and who are inclined to break 
away from their guardians, and to commit suicide. 


The subject of sleep is one of vast importance. 
The condition of sleeplessness is so deplorable as to 
stimulate not only our sympathy, but our best 
eflforts for its relief. We can do this if we secure the 
confidence of our clients, and then patiently and per. 
severingly toil in their behalf. We should give up 
over-mastering hypnotics, and use homeopathic 
remedies instead. We should banish morphine from 
the bedroom of the sleepless, and introduce hot milk 
instead. We should remember that beyond the tem- 
porary relief afforded by large doses of hypnotics, we 
may find safety and efficacy in 

" Many simples operative 
Whose power will close the eye of anguish." 

That was a wise injunction of Meander when he 
declared that ** sleep is the natural cure of all dis- 
eases.'* To be so, however, it must be induced by 
mild, and not by savage measures. "Let us, then, 
cultivate sleep— not the sleep of sloth and inertia, 
not the listless revery of ennui, not the keff of the 
Arab or the noonday siesta of the tropics, but that 
other and nobler Somnus, whose temple, opening 
only at nightfall, invites the weary, day-worn 
traveler to rest. Here, with the silent stars for his 
everlasting ministers, he sits enthroned in halls of 
sweet obliviousness, waiting with the lavish and im- 
partial affection of a parent, to crown us all with 
the poppy wreaths of sleep." 



Theories, Definitions, and Forms of 


We shall speak to-day, very briefly, of the history 
of insanity, and also give some classifications of this 
disease, together with theories and definitions. 
Again, we shall speak of the legal forms of commit- 
ment to hospitals for the care of the insane, and ad- 
vise you when to commit and when to refi"ain from 
so doing. 

The earliest reference to insanity is found in the 
book of Deuteronomy. There the Lord, through 
Moses, makes promises to those who are good, and 
and threats against those who are bad ; and among 
other visitations we note: **So thou shalt be mad 
for the sight of thine eyes which thou shalt see.'' 
Again, we find in Samuel, concerning David: "And 
he changed his behaviour before them and feigned 
himself mad in their hands, and scrabbled on the 
door-posts of the gate, and let his spittle fall down 
upon his beard.'' That was a cunning and success- 
ful feigning of insanity. Feigning insanity, under 
distressing circumstances, has been one of the 
achievements of mankind throughout the centuries. 
Again, in Ecclesiastes : "I said of laughter, it is 
mad ; and of mirth, what doeth it ? " This is a fair 
description of the condition known as dementia. 
The preacher also says : " Surely oppression maketh 


a wise man mad/* Here is another ancient but 
eternal truth, for oppression, if long-continued, is a 
-well-known cause of insanity. Jeremiah declares, 
concerning the wine cup : '* And they shall drink and 
be moved and be mad.*' And concerning religious 
matters, he says: "For every man that is mad and 
maketh himself a prophet, that thou shouldst put 
him in prison, and in the stocks.'' And once more: 
**They are mad upon their idols." In these state- 
ments of priest, prophet, and psalmist, we learn 
something of the causes and conditions of insanity. 
Not only individuals but nations were poisoned 
by the wine cup in ancient times, for Jeremiah also 
says : "Babylon has been a golden cup in the Lord's 
hands, that made all the earth drunken. The 
nations have drunken of her wine, therefore the 
nations are mad." It is a universal fact that unwise 
and intemperate use of any of the blessings of life 
brings inevitable retribution. On the other hand, 
the temperate enjoyment of those things which the 
Creator has made possible is the best way to live. 

Greek w^riters speak of cases of mental aberration 
as occurring with some frequency in Greece. The in- 
habitants of the Roman Empire, from the crazy king 
Nero to the humblest citizen, were afflicted with 
mental unsoundness; and in ancient Egypt we find 
that the Egyptians had temples and priests for the 
care of the insane. 

Hippocrates, who flourished about four hundred 
years before Christ, w^as the first physician w^ho 
seemed to have any true conception of the real 
nature of insanity. He believed that to a certain 
extent insanity was due to physical disturbances, 
and yet for many centuries later the masses believed 
that madness was simply a visitation of the devil. 


In the time of Christ the insane were permitted to 
w^ander at large among the woods and in the caves 
of Palestine. Six centuries after Christ, the monks 
of Jerusalem built the first hospital or asylum for the 
care of the insane. A century later the fame of St. 
Dymphna had extended over Europe, from the little 
village of Gheel, in Belgium, and those afflicted with 
mental diseases were taken to her shrine for the 
purpose of being cured. 

You will remember that St. Dymphna was an 
Irish princess who resisted the assaults of an un- 
natural father, and fled to Belgium, where she 
engaged herself in the care of the sick. Her father 
pursued her, and found her, and cut off* her head in 
one of the streets of Gheel. Two insane persons saw 
the blood gush from her neck, and the shock immedi- 
ately cured them of their insanity. From that time 
on St. Dymphna became the patron saint of mental 
invalids, and the example of her purity of life has 
been an invisible but potent power for the restora- 
tion of the insane from that day to this. 

In the year 1409 a hospital for the insane was 
established at Valencia, in Spain. In the year 1547, 
the hospital of Saint Mary of Bethlehem was estab- 
lished near London. This institution was known as 
** Bedlam '* for a long time, a name notorious in the 
history of London. 

The first asylum established upon reform princi- 
ples was St. Luke's in London. This was founded in 
1751. About the year 1791, Samuel Hahnemann, 
the expounder of homeopathy, established an 
asylum for the insane at Georgenthal, near Gotha> 
and in this institution the law of kindness was the 
unvarying rule. Hahnemann, in his ** Lesser Writ- 
ings," says: **I never allow any insane persons to 


be punished by blows or other corporeal infliction." 
About 1792 or '93, Pinel struck the chains from the 
incarcerated insane at the BicStre, near Paris. 

During the past century there has been a gradual 
tendency toward better things in behalf of those af- 
flicted with mental disease. A hundred years ago 
they were treated with prison surroundings and 
prison fare. Then asylum treatment began to pre- 
vail. This is a higher grade of treatment than that 
bestowed by the prison. Asylum care means close 
confinement, good food, sufficient clothing, and com- 
fortable beds. Asylum care means the humane 
custody of dangerous prisoners. From the asylum 
we move on to the hospital system of caring for the 
insane. The hospital system recognizes the fact that 
the lunatic is a sick man, and needs nursing and 
medical treatment in order to effect a cure. Hospital 
treatment has been gradually introduced during the 
past twenty years or more, and in time it will even- 
tually supercede asylum treatment, and prison or 
workhouse methods in the management of the 
insane everywhere. 

Classification of Insanity 

We come now to a classification of insanity. 
Many classifications have been made. We wish to 
present to you that which is as brief and simple as 
possible, hence we make the list as follows : 

1. Melancholia, which includes all forms of mental 

2. Mania, which includes all forms of mental ex- 

3. Dementia, which includes all forms of mental 
weakness or failure, except idiocy and imbecility, 

4. General paresis, which is a distinct form of 



mental disease possessing certain characteristics 
^which demand that it shall be classified separately. 
In general paresis you will find conditions of mental 
depression, mental excitement, and mental weak- 
ness ; and in the course of this fatal disease you will 
find that it embodies and embraces some elements of 
all other forms of insanity. 

We present herewith two classifications. One is 
known as the British classification, and the other 
as the American classification. 

British Classification 

I. Congenital, or infantile mental deficiency. 
Idiocy; Imbecility; Cretinism: (a) With epilepsy; 
(6) Without epilepsy. 

II. Epilepsy acquired 

ill. General Paralysis of the Insane 


A potu, or mania of drunken- 







Organic, i. e., from tumors, 
hemorrhages, etc. 

IV. Mania ^ 

Y. Melancholia... h 

VI. Dementia ^ 



I. Mania >.... ^ 

II. Melancholia... - 

VII. Delusional Insanity (Monomania) 
VIII. Moral Insanity 

American Classification 



III. Primary Delusional Insanity, Monomania, 
Subacute Mania (Paranoia?) 

' Primary 

Organic (tumors, hemor- 
rhages, etc.) 

V. General Paralysis of the Insane (General 

VI. Epilepsy (with Mania or Dementia) 

VII. Toxic Insanity (Alcoholism, Morphinism, 

VIII. Congenital or subsequent mental \ ^ t^-vj. 

deficiency \^ ^. . ^ 

•^ V Cretmism 

These classifications are somewhat more elabo- 
rate than the one which I have presented to you, 
and perhaps this elaboration is necessary in making 
up an extensive work upon the subject. They are 

IV. Dementia < 


probably serviceable to alienists, but for the general 
practitioner it may be well to get firmly fixed in 
mind the four general divisions of insanity — ^namely, 
melancholia, mania, dementia, and general paresis, — 
and hold to them as starting points for wider study 
and further investigation. 


There are three theories concerning the nature of 
insanity : 

1. The ancients believed that insanity was a pos- 
session of the devil, — a perversion of the psychical 
forces through the eflfects of sin or crime. 

2. It is believed by some that insanity is a disease 
of both body and mind, or that the physical and 
spiritual forces are both degenerated when under the 
influence of insanity. If the spiritual forces are im- 
mortal, they can never become diseased. 

3. The last and most modem theory is, that in- 
sanity is a departure from the normal mental status, 
as a result of diseased conditions of the brain. In 
other words, insanity is a physical disease, or, at 
least, all mental aberrations are dependent upon 
either functional or organic diseases of the brain and 
nervous system. These conditions of the brain are 
due, we believe, to disordered blood. The blood is 
always perverted in insanity. It is either too thin 
or too thick, and its quality and distribution have 
been impaired before diseased conditions of the brain 
are likely to occur. 

For general purposes, it is well to remember that 
the ancients thought insanity to be a diseased condi- 
tion of the soul, while modern alienists believe that 
insanity is due to a physical disorder. Between 
these two extremes there may be many shades of be 


lief, but it is unnecessary to touch upon them at this 
time. It is essential for the cure of insanity that its 
physical nature should be recognized, in order that 
we may deal with it just as we do with any other 
physical disease. If you can convert a diseased 
brain and a diseased body into a sound and healthy 
brain and body, then you will be likely to have a 
sound mind as the occupant of the healthy human 


Dr. Andrew Combe declares insanity to be a 
*' prolonged departure, without an adequate ex- 
ternal cause, from the states of feeling and modes of 
thinking usual to the individual when in health. 
This is the true feature of disorder in mind." A 
general definition of mental disorder is this: In- 
sanity is a departure from the normal mental status 
of the individual, and this departure is due to some 
diseased condition of the brain or nervous system. 
Of course there may be temporary departures from 
the normal mental status, as when an individual 
gets drunk, and becomes hilarious, or delirious, or 
besotted, or stupid. But that condition passes 
away as soon as its cause evaporates, which is 
usually in a few hours. Then, too, there may be dis- 
eased conditions of the brain which do not disturb 
the serenity and stability of the mind — ^that is, some 
minds are so strong that they hold themselves in 
proper poise even when the home of that mind (the 
brain) is in a disordered state. 

From a medical standpoint, insanity means 
mental aberration due to a diseased condition of the 
brain. From a legal standpoint, insanity means 
mental unsoundness developed to such a degree that 


the victim is relieved from responsibility in case he 
should commit a crime. Or the mental disorder is 
carried to such an extent that the afficted person 
cannot assume responsibility, or perform the ordi- 
nary duties of life, such as the making of a will, the 
conveying of property, the contracting of debts, or 
the incurrence of the solemn obligations of matri- 

Thus you will see that insanity from a medi- 
cal standpoint and insanity from a legal stand- 
point diflfer mainly in degree. A person suffering 
with simple melancholia might be considered insane 
and in need of medical treatment, while at the same 
time this person could exercise judgment, assume re- 
sponsibility, and perform the ordinary duties of life. 
But when insanity has developed to such an extent 
that self-control is lost, or greatly impaired, and 
judgment and will are seriously disturbed, or re- 
duced in action, then the person is insane from a 
legal standpoint. 

Some of the principal words used in the nomen- 
clature of insanity are delusion, hallucination, and 

A delusion is a false belief. There are both sane 
and insane delusions. A sane delusion is a false belief 
which comes as a result of imperfect education. A 
child may be taught to believe in Santa Claus, and 
he may actually put all his faith in that supposed 
individual. But this false belief in Santa Claus is a 
sane and harmless delusion. It is a delusion which 
the child outgrows when he gets a little further on 
in life. An insane delusion is a false belief independ- 
ent of education or teaching, and it springs from a 
diseased condition of the brain. If a man becomes 
sleepless, restless, and expansive in his ideas by 


reason of an inflammatory condition of the brain, 
and while actually poor he comes to think of himself 
as worth a hundred millions of dollars, he is said to 
have an insane delusion. 

We will now proceed to the consideration of de- 
lusions in their relations to positive insanity. These 
delusions are multitudinous in number, and of the 
most diverse and opposite character. They sweep 
the gamut of demoralized human passion. They fill 
the cup of their possessor with the gall of intensest 
sorrow, or they cause it to overflow with perpetual 
joy. They conjure up the gloomiest forebodings of 
future ills, or they arch the troubled sky of the de- 
sponding with a rainbo\sr of ecstatic hope. They 
plunge their victim into deepest hell of despair, or 
they bear him aloft to some heavenly elysium. Such 
are the diverse emotions and pathways of those 
who are given over to the balefiil influences of insane 

Man^s natural course is of an even tenor, and 
w^hatever produces undue exaltation or depression 
tends to the dethronement of human reason. A 
natural division of delusions may, therefore, be made 
under two heads, — namely, delusions made manifest 
by mental exaltation, and delusions which grow out 
of or are the effects of profound mental depression. 
In the former case incoherency of thought and con- 
stant change of ideas are quite common. In the 
latter a steady and fixed contemplation of a single 
idea is noticeable. In either case the cause of 
delusion rests in some abnormal condition of the 
brain. The most marked delusions are those of the 
general paretic, whose tendencies to ideas of 
grandeur and exhaustless wealth are well-known. 
In these cases there are changes in the membranes 


and cortex of the brain. Inflammatory adhesions 
are usually found upon the surfaces of the anterior 
and middle lobes of the brain in the paretic. In 
mania, where the delusions are remarkably kaleido- 
scopic in their manifestations, there is usually an in- 
flammatory condition of the blood vessels them- 
selves, which conditions, often varying, may account 
for the marvelous variations of mental action and 
the development of protean-hued delusions. In 
melancholia there is a greater fixedness of mental 
aberration than in mania, and there is also greater 
uniformity of pathological change, the usual condi- 
tion of the brain in melancholia being that of pass- 
ive venous congestion. 

Delusions may result from a diseased condition of 
the brain, produced by either internal or external 
impressions. For instance, as a result of disease 
located primarily in the lungs, the heart, the liver, 
the stomach, the kidneys, or the bowels, the brain 
may be so impressed by reflex action that the victim 
comes to believe that he is on fire, that he is made of 
glass, that he has an animal in his abdomen, or that 
he is possessed by the devil. On the other hand, a 
person may receive an unpleasant impression from 
the sight of some horrible object, or from some 
action on the part of those around him, and such 
impression, developing an irritation of the brain, 
may come to produce at first a false conception of 
fact, and finally a delusion that he is being pursued, 
or poisoned, or injured, or robbed, or slandered. In 
the same way these impressions may stimulate the 
faculties of imagination and hope until the patient 
concludes that he is the possessor of boundless 
wealth, or holds sway undisputedly over the realms 
of imaginary empire. 


An hallucination is **a sensation without an ob- 
ject," according to M. Ball, of Paris. Thus it is said 
that an individual who hears voices when no sound 
strikes the ear has an hallucination. Hallucina- 
tions, to speak plainly, are false perceptions through 
any one of the senses. There are hallucinations of 
hearing, of sight, of smell, of taste, and of feeling. 

Hallucinations are of two varieties: (1) Those 
which indicate a temporary and unimportant dis- 
eased condition of the brain, as, for instance, visions 
and nightmare, particularly in the young; and, (2) 
those which indicate profound mental aberration. 
As a result of a simple congestion, a person may see 
two objects on the wall where but one exists ; or he 
may see stars or rings floating in the air, or angels 
in the sky. As the result of a drinking bout, a person 
may see snakes, or black dogs, or vermin. The same 
effects may be produced temporarily by such drugs 
as Belladonna, Stramonium, or Cannabis Indica. 

Harmless hallucinations are temporary in their 
nature, and the victim may often be brought to 
realize their falsity. Hallucinations indicating in- 
sanity are fixed, permanent, and intractable in their 
nature. The insane man constantly reiterates what 
he supposes to be a fact, that he sees animals or 
objects, or that he hears voices, and no amount of 
argument or ocular demonstration will relieve his 
mind from the erroneous conclusions which he 
draws from these false perceptions. Sometimes a 
patient wU temporarily deny that he is troubled 
with hallucinations, but this denial is generally of 
short duration. 

Now it often happens that delusions spring up in 
the mind as a result of hallucinations. Hallucina- 
tions affect the sensory motor gangha. Delusions 


find their home in the inhibitory motor centers, or 
centers held in check by the influence of other nerve 
centers. As in the ordinary action of the brain, -we 
first receive impressions and then perceptions, and 
form conclusions and judgments by the transmission 
of these impressions from one set of brain cells to 
another, so among the insane these false perceptions 
make their impress upon the primary sensory gang- 
lia, and finally transmit these impressions to the 
ideational centers. The natural result of these im- 
pressions is a false judgment of external things, and 
hence a false belief. And as a natural sequence of 
these false beliefs, we have that unnatural speech or 
action which indicates insanity, or a departure from 
the normal mental status of the individual. 

It is generally considered among alienists that 
the presence of hallucinations in a case of insanity is 
an unfavorable symptom. The reason for this, we 
believe, lies in the fact that those portions of the 
brain which have been most thoroughly developed 
by constant use, and which are therefore the strong- 
est, have become diseased. The ideational centers 
may remain dormant and inactive from lack of use, 
but those centres which receive impressions of ex-, 
temal things through the senses are always, from 
the very nature of the things, subjected to steady 
and persistent toil ; consequently they become hard- 
ened by use, like the brawn of the blacksmith, and 
are therefore enabled to resist the ordinary attacks 
of disease. Hence, when these strongholds of brain 
power are broken down by overuse, and their best 
forces are scattered by the blinding storm of in- 
sanity, their rebuilding becomes a matter of grave 
and protracted doubt. 

Physically speaking, hallucinations are due to 

J I 


imperfect, or insufficient, or changed, or defective 
nutrition of the brain substance. They may arise 
from congestion, from anemia or from atheroma- 
tous condition of the vessels, which latter may pro- 
duce an irregular blood supply. 

**It is a singular fact,*' says Blandford, "that a 
person who is blind, either from disease of the ex- 
ternal organ or the internal sensory ganglia, may 
yet see with the mind's eye, and reproduce in memory 
the appearance of objects which he has stowed away. 
Now we may suppose that in case of an hallucina- 
tion, the internal organ is excited not from without, 
as ordinarily happens, but downwards from the ide- 
ational portion of the brain. Accustomed, however, 
as he is to connect all the sensations experienced with 
the external organ and the external world, the 
patient fails to perceive, sometimes at any rate, that 
the excitation is from within, and is firmly im- 
pressed with the belief that the sight, which the 
organ of sight apparently sees, and the voice he 
apparently hears, comes from without and not from 
within. The idea strikes his sensory ganglia so for- 
cibly that the shadow becomes a reality, which per- 
chance may not be removable by demonstration or 
argument.'' In the main, we think this idea of the 
learned doctor is correct. We have had under our 
charge several blind people, whose blindness was 
acquired. These have been insane, and have ex- 
perienced hallucinations of sight. We have known 
deaf people to be troubled with hallucinations of 
hearing. But we have never known a person who 
was bom blind or deaf to be afflicted with hallucina- 
tions of sight or hearing. It seems, therefore, neces- 
sary, in order that the ideational centers may pro- 
duce a conception of external objects or sounds, that 


they shall first have been the recipients of similar 
conceptions through external impressions. 

As we have already stated, persons suffering with 
hallucinations do not readily recover. We may 
state, however, that hallucinations of sight among 
those suffering from acute insanity do not preclude 
recovery. Hallucinations of hearing are considered 
more unfavorable than those of seeing. Even here, 
however, we may not pronounce an utterly unfavor- 
able prognosis. Other conditions are to be con- 
sidered in our final judgment of the case. 

Hallucinations of taste are usually very persistent. 
One of our patients has for several years had an hal- 
lucination that her tongue is covered with ink or 
blood. Upon this symptom we gave an unfavorable 
prognosis, and time has too sadly proven the cer- 
tainty and the validity of that opinion. 

Hallucinations of feeling are, fortunately, quite 
uncommon. When once established, however, their 
victims rarely yield them up. One patient thinks 
that she is turning into bone ; another that he has a 
child in his abdomen; another that her heart and 
lungs are being cut out; while still another feels 
kerosene trickling down the back, and thinks that 
somebody is setting fire to it. These are all hal- 
lucinations of feeling which breed fixed and perma- 
nent delusions. 

An illusion is a mistaken perception. The victim 
may see a ball rolling on the floor, and may fancy 
that it is an animal coming to destroy him. A 
person may hear the sighing of the wind, and believe 
that he hears angels singing to him, or demons 
threatening him with some dire disorder. These are 
illusions. They partake somewhat of the character 
of hallucinations, but are still more closely allied to 


delusions. The latter is a false belief relating to 
some physical, or mental, or spiritual fact— that is, 
relating to some of the ordinary experiences or 
phenomena of life,— while the former also relate to 
some material existence whose qualities or attri- 
butes are mistaken by the beholder. 

Like an hallucination, an illusion may be of 
temporary or transient nature ; or, if prolonged, the 
patient may still be convinced of its falseness, in 
which case these spectral sights produce no marked 
change in the conduct or habits of thought of the 
individual. It is a blessed fact that visions strange 
may rise up before us, yet fail to frighten us from the 
path of sanity ; and it is also a consoling truth that 
"thoughts impure may pass through minds of 
angels and of men, and leave no stain.'' In the case 
of man, this results because the brain is healthy. It 
is only when the hot iron of disease has seared and 
scorched the brain to its depths, that the mind is dis- 
torted in all its workings ; and it is then only that 
delusions, and hallucinations, and illusions creep like 
shadowy ghosts into the dilapidated and ruined 
chambers of the soul, and refuse to be exorcised by 
the wand of modem science. 

Mental unsoundness is designated by several 
terms. The victims of this unsoundness are called in- 
sane; they are called lunatics because it was once 
supposed that the moon affected the insane ; they are 
called crazy because the term signifies an unnatural 
degree of mental excitement. When speaking of the 
insane in their presence, you should never use any of 
these old-fashioned terms, but you should speak of 
them as mental invalids, suffering with distresses of 
the mind. Such persons demand as much tender 


care and kindly sympathy as do those who suffer 
with physical pain. 

Requirements for Legal Commitment 

The requirements for a legal commitment to a 
hospital for the insane in the State of New York are 
as follows : 

* ** A person alleged to be insane, and who is not in 
confinement on a criminal charge, may be committed 
to and confined in an institution for the custody and 
treatment of the insane upon an order made by a 
judge of a court of record of the city or county, or a 
justice of the supreme court of the judicial district, in 
which the alleged insane person resides or may be, 
adjudging such person to be insane, upon a certifi- 
cate of lunacy made by two quahfied medical ex- 
aminers in lunacy, accompanied by a verified peti- 
tion therefor, or upon such certificate and petition, 
and after a hearing to determine such question, as 
provided in this article. The commission shall pre- 
scribe and famish blanks for such certificates and 
petitions, which shall be made only upon such 
blanks. An insane person shall be committed only 
to a state hospital, a duly licensed institution for the 
insane, or the Matteawan State Hospital, or to the 
care and custody of a relative or committee, as here- 
inafter provided. No idiot shall be committed to or 
confined in a state hospital. But any epileptic or 
feeble-minded person becoming insane may be com- 
mitted as an insane person to a state hospital for 
custody and treatment therein. 

"The certificate of lunacy must show that such 


Chap. 545, Laws of 1896, Art. 3, sections 60, 61, 62, 63, and 


person is insane and must be made by two reputable 
physicians, graduates of an incorporated medical 
college, who have been in the actual practice of their 
profession at least three years, and have filed with 
the commissioner a certified copy of the certificate of 
a judge of a court of record, showing such qualifica- 
tions in accordance with forms prescribed by the 

'*Such physicians shall jointly make a final ex- 
amination of the person alleged to be insane within 
ten days next before the granting of the order. The 
date of the certificate of lunacy shall be the date of 
such joint examination. Such certificate of lunacy 
shall be in the form prescribed by the commission, 
and shall contain the facts and circumstances upon 
which the judgment of the physicians is based, and 
show that the condition of the person examined is 
such as to require care and treatment in an institu- 
tion for the care, custody and treatment of the 

** Neither of such physicians shall be a relative of 
the person applying for the order or of the person 
alleged to be insane, or a manager, superintendent, 
proprietor, officer, stockholder, or have any pe- 
cuniary interest, directly or indirectly, or be an at- 
tending physician in the institution to which it is 
proposed to commit such person. 

"Any person with whom an alleged insane per- 
son may reside or at whose house he may be, or the 
father or mother, husband or wife, brother or sister, 
or the child of any such person, and any overseer of 
the poor of the town, and superintendent of the poor 
of the county in which any such person may be, may 
apply for such order, by presenting a verified peti- 
tion containing a statement of the facts upon which 


the allegation of insanity is based, and because of 
which the application for the order is made. Such 
petition shall be accompanied by the certificate of 
lunacy of the medical examiners, as prescribed in the 
preceding section. Notice of such application shall 
be served personally, at least one day before making 
such application, upon the person alleged to be in- 
sane, and if made by an overseer or superintendent 
of the poor, also upon the husband or wife, father or 
mother or next of kin of such alleged insane person, 
if there be any such known to be residing within the 
county, and, if not, upon the person w^ith whom such 
alleged insane person may reside, or at whose house 
he may be. The judge to whom the application is to 
be made may dispense with such personal service, or 
may direct substituted service to be made upon some 
person to be designated by him. He shall state in a 
certificate to be attached to the petition his reason 
for dispensing with personal service of such notice, 
and if substituted service is directed the name of the 
person to be served therewith. 

**The judge to whom such application is made 
may, if no demand is made for a hearing in behalf of 
the alleged insane person, proceed forthwith to deter- 
mine the question of insanity, and if satisfied that 
the alleged insane person is insane may immediately 
issue an order for the commitment of such person to 
an institution for the custody and treatment of the 
insane. If, however, it appears that such insane per- 
son is harmless and his relatives or a committee of 
his person are willing and able to properly care for 
him, at some place other than such institution, upon 
their written consent the judge may order that he 
be placed in the care and custody of such relatives or 
such committee. Such judge may, in his discretion, 



require other proofs in addition to the petition and 
certificate of the medical examiners. 

"Upon the demand of any relative or near friend 
in behalf of such alleged insane person, the judge 
shall, or he may upon his own motion, issue an 
order directing the hearing of such application before 
him at a time not more than five days from the date 
of such order, which shall be served upon the parties 
interested in the application and upon such other 
persons as the judge, in his discretion, may name. 
Upon such day, or upon such other day, to which 
the proceeding shall be regularly adjourned, he shall 
hear the testimony introduced by the parties and 
examine the alleged insane person if deemed advis- 
able, in or out of court, and render a decision in 
writing as to such a person's insanity. If it be 
determined that such person is insane, the judge 
shall forthwith issue his order committing him to an 
institution for the custody and treatment of the 
insane, or make such other order as is provided in 
this section. If such judge cannot hear the applica- 
tion he may, in his order directing the hearing, name 
some referee, who shall hear the testimony, and 
report the same forthwith, with his opinion thereon, 
to such judge, who shall, if satisfied with such 
report, render his decision accordingly. If the com- 
mitment be made to a state hospital, the order shall 
be accompanied by a written statement of the judge 
as to the financial condition of the insane person and 
of the persons legally liable for his maintenance as 
far as can be ascertained. The superintendent of 
such state hospital shall be immediately notified of 
8uch commitment, and he shall, at once, make pro- 
visions for the transfer of such insane person to such 


**The petition of the applicant, the certificate in 
lunacy of the medical examiners, the order directing 
a farther hearing as provided in this section, if one 
be issued, and the decision of the judge or referee, 
and the order of commitment shall be presented at 
the time of the commitment to the superintendent or 
person in charge of the institution to which the 
insane person is committed, and verbatim copies 
shall be forwarded by such superintendent or person 
in charge and filed in the office of the state commis- 
sion in lunacy. The relative, or committee, to 
whose care and custody any insane person is com- 
mitted, shall forthwith file the petition, certificate, 
and order, in the office of the clerk of the county 
where such order is made, and transmit a certified 
copy of such papers to the commission in lunacy, 
and procure and retain another such certified copy. 

**The superintendent or person in charge of any 
institution for the care and treatment of the insane 
may refuse to receive any person upon any such 
order, if the papers required to be presented shall not 
comply with the provisions of this section, or if, in 
his judgment, such person is not insane within the 
meaning of this statute, or, if received, such person 
may be discharged by the commission. No person 
shall be admitted to any such institution under such 
order after the expiration of five days firom and in- 
clusive of the date thereof. 

**If a person ordered to be committed, pursuant 
to this chapter, or any friend in his behalf, is dissat- 
isfied with the final order of a judge or justice com- 
mitting him, he may, within ten days after the mak- 
ing of such order, appeal therefrom to a justice of the 
supreme court other than the justice making the 

order, who shall cause a jury to be summoned as in 



case of proceedings for the appointment of a com- 
mittee for an insane person, and shall try the ques- 
tion of such insanity in the same manner as in pro- 
ceedings for the appointment of a committee. Before 
such appeal shall be heard, such person shall make a 
deposit or give a bond, to be approved by a justice 
of the supreme court, for the pa3nnent of the costs of 
the appeal, if the order of commitment is sustained. 
If the verdict of the jury be that such person is in- 
sane, the justice shall certify that fact and make an 
order of commitment as upon the original hearing. 
Such order shall be presented, at the time of the com- 
mitment of such insane person, to the superintendent 
or person in charge of the institution to which the 
insane person is committed, and a copy thereof shall 
be forwarded to the commission by such superin- 
tendent or person in charge and filed in the office 
thereof. Proceedings under the order shall not be 
stayed pending an appeal therefrom, except upon an 
order of a justice of the supreme court, and made 
upon a notice, and after a hearing, with provisions 
made therein for such temporary care and treatment 
of the alleged insane person as may be deemed neces- 

"If a judge shall refuse to grant an application 
for an order of commitment of an insane person, 
proved to be dangerous to himself or others, if at 
large, he shall state his reasons for such refusal in 
writing, and any person aggrieved thereby may ap- 
peal therefrom in the same manner and under like 
conditions as from an order of commitment. 

"The costs necessarily incurred in determining 
the question of the insanity of a poor or indigent 
person and in securing his admission into a state 
hospital, and the expense of providing proper cloth- 


ing for such person, in accordance with the rules 
and regulations adopted by the commission, shall be 
a charge upon the town, city or county securing the 
commitment. Such costs shall include the fees al- 
lowed by the judge or justice ordering the commit- 
. ment to the medical examiners. If the person sought 
to be committed is not a poor or indigent person, the 
costs of the proceedings to determine his insanity 
and to secure his commitment, as provided in this 
article, shall be a charge upon his estate, or shall be 
paid by the persons legally liable for his mainte- 
nance. If in such proceedings, the alleged insane 
person is determined not to be insane, the judge or 
justice may, in his discretion, charge the costs of the 
proceedings to the person making the application 
for an order of commitment, and judgment may be 
entered for the amount thereof and enforced by ex- 
ecution against such person.'* 

We see from the foregoing that in order to effect a 
legal commitment, the following requirements of 
law must be complied with : 

1. A petition. 

2. Personal service. 

3. Examination by two qualified medical ex- 
aminers in lunacy. 

4. Judicial order of commitment by a judge of a 
court of record. 

5. Statement of financial condition of patient. 
Blank forms of commitment, together with initial 

history blanks, are famished by the hospital when 
so desired and deemed necessary. 

All town, county or city authorities before send- 
ing a patient to a hospital must see that said 
patient is in a state of bodily cleanliness, and pro- 
vided with new clothing throughout, including shoes 


and hat. Between the months of November and 
April, both inclusive, there shall be provided, in ad- 
dition to the foregoing, a suitable overcoat for male 
patients and a suitable shawl or cloak for female 
patients ; also gloves or mittens. 

I have given you the method of commitment. A 
very important question may arise in your practice 
as to whether or not a given insane person should 
be sent to a hospital. The rule you should adopt is 
this: You should send to a hospital, in the early 
stages of his disease, an insane person who is 
dangerous to himself or others. That is, you should 
send a person to a hospital who is likely to commit 
suicide or homicide, or who might, under the in- 
fluence of his insanity, destroy valuable property, or 
endanger or greatly distress others by his excite- 
ment, and his unnatural speech or action. You 
should send acute or curable cases to a hospital for 
treatment when it is quite certain that the patient's 
chances for recovery are improved by such pro- 

You should refrain from sending persons to a 
hospital for the insane : 

. 1. When the patients are very old and feeble, and 
cannot do much damage at home. 

2. When the patients are young or middle-aged, 
but so very weak that their lives would be en- 
danged by transportation from their homes to the 
hospital. Such cases should be kept at home until 
they are sufficiently strong to endure the fatigues 
of the journey. It sometimes happens that very 
weak persons are so excited by the journey to a 
hospital that they die soon after being admitted. A 
patient was brought to us after a journey of over 


two hundred and fifty miles, and he lived less than 
fifteen minutes after reaching the hospital. 

3. Those who are not likely to be cured or bene- 
fited by treatment, and who are easily cared for at 
home. There are patients suflFering from imbecility 
or dementia who can be readily cared for by their 
fi^ends, and who, if sent to a hospital, would exert 
a depressing and injurious influence upon patients 
already received, and who may perhaps be restored 
to health. 



We shall speak to-day of that form of insanity 
known as Melancholia. The term melancholia is 
from the Greek /xcAas, ** black/' and x^H " bile.*' The 
name is founded upon the theory of a humoral pa- 
thology, the four humors, according to the ancients, 
being blood, phlegm, yellow bile, and black bile. 
Guislain gives as a synonym of melancholia the term 
Phrenalgia, ** brain pain;'' Rush, Tristimania, "sad 
mania;" Esquirol, Ljrpemania, from Xvttcoj, "to make 

Melancholia is a disease characterized by great 
mental depression. It is an abnormality of mind to 
which all humanity is at times subject. It is a grim 
spectre of despair which enters every theatre of 
mental activity to molest and disturb. We meet it 
on the threshold of life, and through all our joumey- 
ings it hovers over us. 

Some of the sons of men are melancholy by nature. 
They have bilious temperaments ; they look upon the 
sunniest experiences of life through green and yellow 
goggles, and if such men make a feeble eflfort to 
escape from the spirit of melancholy she seizes upon 
them with renewed vigor, and in reply to all plead- 
ings for freedom and happiness she echoes in their 
ears the cry of Poe's Raven — "nevermore." 

"Melancholia," says Maudsley, "is a deep painftil 
feeling of profound depression and misery — a great 
mental suffering. The patient's feelings of external 


objects and events are perverted, so that he com- 
plains of being strangely and unnaturally changed. 
Impressions which should rightly be agreeable or 
only indifferent are felt as painful. Friends and 
relatives are regarded with sorrow or aversion, and 
their attentions with suspicions. He feels himself 
entirely isolated, and can take no interest in his 
affairs, and either shuns society and seeks solitude, 
lying in bed, unwilling to exert himself, or he utters 
his agony in sounds ranging from the moan of dull 
ache to the shrill cry of anguish, or in ceaseless gest- 
ures of misery, or even in some convulsive act of 
desperate violence.*' 


The causes which impel the inception and onset of 
this dread disorder are almost as numerous as the 
experiences of life. Still we may name among the 
prominent causes of melancholia the following : 

1. Predisposition. 

2. Physical disease. 

3. Dissipation. 

4. Work and worry. 

5. Shock from sudden loss of friends or fortune. 

6. Brooding. 

7. Disorders of faith. 

Predisposition. — Predisposition is an unnatural, 
inborn, inherited tendency to look upon the dark 
side of life ; to make the worst of everything ; to con- 
jure up horrors that may never exist; to cross 
bridges before they are reached ; to imagine that an 
enemy lurks behind every tree and stone, and that 
even tried and true friends are not always to be 


Physical Disease. — One of the most common excit- 
ing causes of insanity is physical disease at or after 
the period of maturity. Whatever tends to deplete 
and exhaust the physical system tends to the produc- 
tion of insanity. Physical disease is produced by 
various influences, but chiefly by the reckless extrav- 
agance of the young in making undue drafts, either 
by toil or pleasure, upon the natural resources of the 
system. To be rich, to be great, to be honored, and 
to be loved are ambitions which fill the American 
heart. And the over-zealous struggle for these 
prizes tends to the production of those physical 
diseases which culminate in insanity. 

It frequently happens that the victims of long-con- 
tinued physical disease become depressed. This may 
be the result of pain, or weakness, or exhaustion, or 
a feeling of helplessness, and loss of usefulness. The 
disease known as the grip especially exhausts the 
nervous system, and causes profound mental depres- 
sion. Again, those who suffer with non-limited dis- 
eases are apt to formulate the idea that they will 
never recover, and thus they become depressed. It is 
well to remember, likewise, that a healthy person 
may experience a shock upon his nervous system thr- 
ough losses of some kind, and then become the victim 
of physical disease. At any rate, you generally find 
that patients suffering with melancholia are weaker 
than when in health, and that all the functions of the 
body are sluggish in their action. The bowels are 
constipated, the kidneys are inactive, the respiration 
is labored and incomplete, and the heart's action is 
apt to be slow. The blood is imperfectly purified, 
and a general venous stagnation ensues. The skin 
becomes dry, and greatly impaired in fiinction. The 
bile is not properly eliminated, and the face presents a 


yellow and sallow appearance. Coupled with this 
physical inactivity, we find, most naturally, a slow 
and painful working of the mind itself as a result of 
physical disease. 

Dissipation. — By this we mean that excessive 
drinking, or excessive eating, or excessive exhaus- 
tion of the sexual system, either by natural or un- 
natural means, not infrequently results in a culmi- 
nating attack of melancholia. At the end of a long 
drunken debauch, a man often feels such compunc- 
tions of conscience that he is driven into an attack 
of suicidal melancholia. Hence you read of numer- 
ous cases where a drunken spree is ended by self- 
shooting, or hanging, or poisoning. 

Work and Worry. — Who can calculate the 
dangers that spring from the overwear of work and 
worry ? No people in the world work harder than do 
the American people. This excess of toil might be 
endured with safety were it not for the added grind 
upon the vital forces of a worrying spirit. We toil 
all day for the accomplisnment of a certain purpose, 
and worry all night, with fear and trembling, lest 
the results of our toil may not be the ripest and the 
rarest of all possible fruits. The young worry about 
their studies in school ; they worry about their ap- 
pearance and their prospects w^hen associating with 
others; they worry lest they shall fail to get rich; 
they w^orry lest they shall lose some strongly invit- 
ing prize in life. A great many w^omen are timid and 
anxious and fearful, and look into the future con- 
stantly with strained and tearful eyes. They see 
lions in every path, and they worry lest they shall 
fall into their clutches, and come to harm. Nine- 
tenths of all the worry in this life is not only useless, 
but injurious ; and nothing more certainly leads to a 


continued mental depression than worrying about 
the future of this or the next life. 

Worry about one's prospects, and means, and ac- 
quirements is like sand poured into the bearings of a 
rapidly revolving wheel. The friction and the wear 
are intense; the bearings become overheated, and 
necessity compels oftentimes a dead halt, a cleaning 
out of the bearings, the introduction of the oil of 
rest until the heat subsides ; and only after long and 
vexatious delays may any renewed attempts at 
progress be made. And sometimes worry so ef- 
fectually destroys the bearings in the human vehicle 
as to preclude the possibility of repair, and the pos- 
sibility of future progress. (If you w^ould become 
philosophical and happy, read Menticulture by 
Horace Fletcher). 

Shock. — When a person suddenly hears unfavor- 
able news, such as the sudden death of a husband, 
or a father, or a brother, who is absent, or when a 
mother loses her child after a brief illness, or w^hen 
the breadwinner of the family loses his fortune 
through speculation, or his position through wrong- 
doing, or his health through recklessness of living, 
then comes a sudden and forcible impression which 
diffuses itself throughout and prostrate the entire 
nervous system. This impression, which causes the 
heart to momentarily stand still, and which nearly 
paralyzes the brain, is termed ** shock." The condi- 
tion of the nervous system resulting from shock is re- 
covered from only with great difficulty. The physical 
functions are so much impaired that they work only 
by a terrific strain of the system. The condition is like 
that of delicate machinery w^hich has been ham- 
mered, and bent, and deprived of necessary oil to re- 
lieve the friction. Under the influence of shock upon 


the physical system, the mental state becomes one of 
depression and despair. 

Brooding. — We have spoken of brooding as 
another cause of melancholia. Brooding differs from 
anxiety and worry in this : The person who broods 
over disappointment in life or ambition quietly seeks 
to keep his trouble to himself, while the victim of 
anxiety and worry is quite apt to give expression to 
his feelings, and thus relieve the strain upon him to a 
considerable extent. Quiet brooding over the past 
constitutes a most dangerous tendency to melan- 

Disorders of Faith, — These are numerous and dis- 
tressing. They tend to the formation of strange and 
wonderful delusions relative to the individual rela- 
tionship between himself and his fellows, between 
himself and the great Creator above us, and between 
himself in his mortal sphere, and his relations to the 
undiscovered future. Predisposition, physical causes, 
overwork, worry, shock and brooding, are causes 
associated with daily life and present experiences. 
The disorders of faith are associated with those in- 
tangible subjects concerning present and fixture exist- 
ence, concerning the mortal and immortal, concern- 
ing Creator, creation, and created. It would be well 
if those who suffer from disorders of faith could culti- 
vate a better philosophy, and restrain their unfet- 
tered imaginings, and like little boys before they learn 
to swim, they should only paddle near the shores of 


MelanchoUa may be divided as follows : 

1. Simple melancholia. 

2. Acute melancholia. 

3. Subacute melancholia. 


4. Chronic melancholia. 

5. Melancholia with stupor. 

6. Melancholia with agitation. 

7. Melancholia with resistance. 

8. Acute delirious melancholia. 

9. Hypochondriacal melancholia. 

Symptoms, Courses, and Cases 

Simple Melancholia. — This form of insanity is 
characterized by a continued depression without the 
formation of concrete delusions. An attack of the 
"blues'' is the mildest type of simple melancholia. 
Beyond this, you will find those who are suflfering 
with continued strain of losses, and without ex- 
periencing any especial shock or sudden attack, they 
pass gradually into a fixed state of simple melan- 
cholia. This state sometimes leads to a more severe 
form, but until new developments arise the victim of 
simple melancholia thinks that he is only ** bilious.*' 

A strange feature of simple melancholia is that 
the patient oftentimes can give no reason for the 
change that has **come o'er him like a summer's 
cloud." In the language of Shakespeare, he may say 
to himself: **I have of late (but wherefore I know 
not) lost all my mirth, foregone all custom of exer- 
cises; and, indeed, it goes so heavily with my dis- 
position, that this goodly frame, the earth, seems to 
me a sterile promontory ; this most excellent canopy, 
the air, look you, this brave o'erhanging firmament, 
this majestic roof fretted with golden fire, why it 
appears no other thing to me than a foul and pesti- 
lent congregation of vapors." 

Acute Melancholia, — Acute melancholia is gen- 
erally the result of sotne sudden mental shock pro- 
duced either by loss of friends, reverse of fortune. 


desertion or seduction, physical disease or pain, or 
by any of the great overwhelming casualities, or 
calamities, or convictions of life. At first a sudden 
shock of grief or despair from remorse may merely 
darken or cloud the life of its victim. Then come 
misconceptions of the mission and ends of life. 
Customary occupations and pleasures are forsaken ; 
the natural secretions and excretions of the body are 
hindered and impeded. As the courage fails, so like- 
wise the strength. The patient loses his appetite, 
and as nourishment is taken in insufficient quantities, 
and but poorly assimilated, the patient wastes in 
flesh, and becomes wrinkled and prematurely aged 
in appearance. 

The person suffering from acute melancholia gen- 
erally looks down; keeps quiet; scowls; refrains 
from talking ; dislikes to be spoken to ; is averse to 
the consolations of friends; and in many ways he 
presents outwardly those appearances of degenera- 
tion which are characteristic of inward hopelessness. 

At first the victim of acute melancholia may seem 
to have no definite delusion, but after a short time 
the vast and formless feelings of profound misery 
take shape as a concrete idea. In other words, his 
sorrow is condensed and crystallized into some defi- 
nite delusion. The patient comes to believe that he 
has committed a great crime, for which he must 
suffer death; that he has blasted the happiness of his 
family ; that he is possessed of the devil, or that he is 
the victim of a persistent and cruel persecution by 
electricity, or by magnetism. And again, he has 
committed the unpardonable sin, and is forever 
damned. The delusion is not the cause of the feeling 
of misery, but is engendered by it. These unhallowed 
fancies take shapes according to the patient's culture 


and education. What the uneducated and supersti- 
tious attribute to witches or to devils the man of 
culture ascribes to electricity, or magnetism, or 
political conspiracy. In certain cases it is striking 
how disproportionate the delusion is to the extreme 
mental anguish ; how^ inadequate it is as the expres- 
sion of it. One whose agony is that of the damned 
will swear that it is because he has drunk a glass of 
beer w^hich he should not have done, or because he 
has muttered a curse when he ought to have oflFered 
a prayer. With him who believes that he is doomed 
to infinite and eternal misery, it is not the delusion 
but the affective disorder that is the fundamental 
fact. There can be no adequate or definite idea of 
the infinite or eternal, and the insane delusion of 
eternal damnation is but the vague and fiitile at- 
tempt at expressing an unutterable real suffering. 

It is noteworthy, again, how much the affliction 
of the melancholiac subsides when a definite delusion 
is established. The vast feeling of vague misery 
which possessed the w^hole mind has undergone sys- 
tematization in definite morbid actions. When the 
delusion is not active, but reposes in the background, 
the patient may be tolerably cheerful. 

A suicidal feeling is common in cases of acute 
melancholia. Hence a patient suffering with this 
form of insanity should always be watched and 
cared for, lest in some paroxysm of agony he should 
seek both to kill some of his friends and himself. 

Acute melancholia may terminate in recovery, or 
it may culminate in an attack of mania. If death 
ensues, it usually results from exhaustion. 

No. 5,414, set. 28, unmarried, was a case of acute 
melancholia in a woman, resulting from overwork, 
and a love affair of an improper nature. The patient 


was a dressmaker, hence her life was necessarily 
sedentary, and the opportunity for exercise in the 
open air was limited. Such conditions are apt to 
produce tendencies to mental depression. The dura- 
tion of the attack previous to admission to the 
hospital was about six months. When she came 
under our care the patient's general health was 
much impaired, and she had lost considerably in 
weight. The mental condition was that of profound 
depression, coupled with anxiety. She was also 
suicidal, and had threatened to kill others. It is not 
uncommon for a case of suicidal melancholia to 
make an assault upon others just previous to self- 
killing. People who try to kill others, and then try 
to kill themselves, labor perhaps under the old-time 
theory that ** misery likes company. *' 

The patient in question w^as sleepless, emaciated, 
and showed numerous scars and abrasions from self- 
mutilation. She w^as also constipated, and had a 
poor appetite. The will power was very weak, and 
she needed constant reassurances from nurses and 
doctors to the eflfect that her **soul was not lost.'* 
The expression in her face was that of hopelessness, 
which is so characteristic of acute melancholia, and 
yet the patient was tractable, and willing to obey 
the directions of the attending physicians. In a short 
time, under suitable care, she was taking liquid food 
in abundance, and sleeping better than at first. She 
also became more cheerful in spirits. About six; 
weeks after admission to the hospital, she was 
troubled with sexual excitement at times, and had 
difficulty in keeping her mind off improper subjects. 
She had amorous dreams. This revival of activity 
in the sexual organs is sometimes an indication of 
improvement in cases of melancholia. In due time 


the menstrual function was renewed, and there was 
an improvement in spirits, and an increase in flesh. 
Having commenced to improve, the gain in bodily 
weight and in lightness of spirits was steady, until 
she made a full recovery. She went home in less than 
six months from the date of her admission. Her 
weight was 127 pounds, showing a gain of 22 
pounds during her stay in the hospital. 

The remedies which this patient received while 
tinder treatment were Ignatia, Picric Acid, Pulsatilla, 
Cantharis, and Cimicifuga. 

Here was a case of acute melancholia in a young 
person, caused by what seemed to her an over- 
whelming misfortune, and which brought on all 
those mental and bodily symptoms which make the 
diagnosis clear and positive. When placed under 
treatment, and compelled to live in a careful and 
methodical way, she became more philosophical and 
serene in mind. The gain in bodily weight w^as 
synchronous with the resumption of normal and 
elastic spirits. Every such case is an exemplification 
of the old adage, to the effect that a sound mind is 
to be found only in a sound body. The rebuilding of 
the physical health in a worn, emaciated and de- 
pressed individual, is the first step toward a satis- 
factory recovery. 

Subacute Melancholia, — ^Under the head of sub- 
acute melancholia we class those cases which, from 
a natural predisposition, incline to a survey of life 
from the dark side. It is often difficult to determine 
in this class where sanity leaves off* and insanity be- 
gins. The patients do not present the marked ob- 
jective symptoms of mental agitation and physical 
decay which present themselves in acute melan- 
cholia, nor do they develop the fixed delusions so 


generally held by those suffering with the chronic 

Subacute melancholiacs are mercurial in their 
nature, now rising to heights of sunny pleasure, and 
again slowly sinking to the depths of despondency. 
Such cases may . recover, or they may drift into a 
chronic state. If they do recover, they are quite 
likely to suffer relapses. Their only hope is to join 
their fortunes with those who are strong, vigorous, 
and exuberant in spirits. They should live in the 
mountains, and in the open air. 

Chronic Melancholia, — Chronic melancholia is the 
terminus of all other forms of spirit depression. It 
is the inevitable goal of continued mental shock, and 
worry, and brooding, and physical decay. The term 
is an epitome of all the disappointments of fickle 
fortune. The condition is a sarcasm upon human 
happiness, and the ultimate of vengeful fate. The 
means to this end are false and unsatisfying philo- 
sophies. Its field of operation is wide as the world, 
and the number of victims which this Giant Despair 
claims for his own is as myriad and legion. 

Chronic melancholia is a grim and ghastly entity ; 
a fetid reminder of better and brighter days ; a sad 
relic of unprofitable and useless existence ; a symbol 
of blasted hopes, broken plans, and a ruined life. 

Patients suffering with chronic melancholia may 

live for years, mourning constantly over their fate, 

repeating daily their threadbare delusions; always 

looking into the darkness, and never seeing a ray of 

sunlight, until at last, worn and wasted by useless 

worriments and forebodings, their lives are finally 

exhausted, and their spirits shattered by continued 

beatings against the bars of a relentless fate. 

Phthisis, marasmus, dropsy or death from ex- 


haustion are the sequelae of chronic melancholia^ 
although occasionally a case recovers. 

Just here we desire to present a brief history of a 
remarkable case. The case is remarkable in these 
particulars : First, from overwork and over-anxiety 
the patient passed into a condition of acute melan« 
cholia ; secondly, from acute melancholia she passed 
into a condition of subacute mania, with marked 
delusions and semi-exaltation ; thirdly, she subsided 
into the passive, non-elastic state which may be 
described as subacute melancholia; fourthly, she 
passed into chronic melancholia ; and, fifthly, after a 
lapse of ten years, she fully and substantially re- 

Miss W., aet. 29, while overtaxed from constant 
daily labor as a teacher, was subjected to excessive 
mental excitement, agitation and anxiety from 
sympathy for a sister who was in great danger dur- 
ing instrumental labor. She was also much over- 
worn by the subsequent illness and death of the 
sister's child, the care of which fell heavily upon her. 
As a result of these severe toils, she was attacked 
with headache, vertigo, ringing in the ears, and 
slight delirium. She had a rapid pulse, a flushed 
face, and wild, wandering eyes at times. Her tongue 
was coated white, and she had thirst, constipation, 
scanty urine, restlessness, agitation, and sleepless- 
ness. In about three weeks after the inception of 
her attack there was an apparent gradual amend- 
ment. The fever subsided, the tongue cleaned, the 
appetite and the general health improved, but there 
yet remained a disordered mind, more or less gastric 
disturbance, and some emaciation. She still re- 
mained restless and sleepless, and indulged in false 
beliefs and false judgments. The patient was. 


strongly conceited, and had fall faith in the correct- 
ness of her o^wn judgments ; fancied that her friends 
were all insane ; that people were constantly watch- 
ing her; was in dread of being buried alive; often 
fancied herself a dog, and indulged in numerous 
other false impressions. With these false beliefs and 
judgments she had such recklessness, and such disre- 
gard for the rules and usages of the family, that she 
not only interfered with the ordinary comfort of her 
friends, but excited grave apprehensions in the minds 
of those around her, lest she should do them or her- 
self some bodily harm. This patient was naturally 
affable, amiable, of nervo-bilious-sanguine tempera- 
ment, and of cultivated and refined tastes. At times 
she was quiet, and again very restless, and still alto- 
gether moody and irritable. 

The patient, after admission to the hospital, at 
first complained of pain in the back and side of the 
head, ringing in the head, constriction and stiffness 
about the head and face, a parched feeling of the 
mouth ; tongue felt as if burned on the sides and tip, 
bowels constipated, sensation of falness after eating, 
a numbness of the body, depressed spirits. She said : 
"I don*t see any use in living if I can't do any one 
any good." She was worse in the house, and about 
sunrise; later in the day and out-of-doors, she felt 
somewhat better. The patient was always self-con- 
ceited, and at times quite emphatic in the expression 
of her disdain for others. She was given Platinum, 
and this remedy was continued for some time. Four 
months later her menses appeared for the first time, 
and after that she seemed a little better for a while. 
She thought she was "coming out of a cloud," and 
that she would feel better again. Then she thought 
that the steeple, which was being put upon one of 


the new buildings at the institution, was a gallows 
on which to hang her. Soon afterwards she realized 
that she had worked too hard, and that this was the 
cause of her suiBFering. The following year she 
settled into a dull, heavy, gloomy state. Her active 
delusions had in a measure subsided ; and at times 
she brightened a little, and then would settle to the 
old plane of living and thinking. Two years later 
she began to be a trifle more sensitive. Passing 
from a subacute to a chronic stage she became more 
irritable and suspicious, and was inclined to write a 
good deal. Her letters were fretful and faultfinding 
reiterations of her troubles and her woes. Again, 
she passed into a state of slight exaltation. She 
played upon the piano for the patients at regular 
chapel services for a time, and then sent in a bill for 
one hundred thousand dollars, reckoning at twenty- 
five thousand dollars per year, and charging for four 
years, when she had been in the hospital but three 
years. Later the patient complained of frequent 
pains in her head, and had several attacks of nose- 
bleed. She felt as if her head were coming off; had 
frequent dreams ; had a cough, with greenish expec- 
toration, and much rattling in the throat and chest. 
For these latter symptoms she received at one time 
Mercurius lod., and at another time Antimonium 
Tart. The next year she had frequent attacks of 
diarrhoea, which came on in the night and towards 
morning, and these were relieved by Podophyllum. 
She was troubled with hoarseness, but no cough. 
She also had smooth, dark-red, non-vascular erysip- 
elas on the extremities. She had bleeding hemor- 
rhoids, with constipation, and severe lancinating 
pains running up the rectum. The remedies for that 


year were Podophyllum, Phosphorus, and Corrosive 

In the early part of the following year the patient 
ran down to seventy-nine and a half pounds in 
weight ; complained of neuralgic pains in the head, 
face and jaws. During the latter part of the same 
year she began to gain in flesh, and continued to 
gain until she weighed eight-five and a half pounds. 
She complained that people were laughing at her; 
was tyrannical in disposition, and troublesome on 
the ward among other patients; complained of 
pains in neck, shoulders and arms, with numbness 
in the latter at times. She also complained of sharp, 
cutting pains while urinating. This condition was 
relieved by Cantharis. She continued to gain in 
weight, but the following year she became dull and 
sleepy at times, and had dull pains over the eyes in 
the forehead; was somewhat feverish, and com- 
plained of her heart feeling as if it would stop. The 
patient had a severe attack of tonsillitis, and there 
was considerable swelling in the throat. Gelsemium, 
Belladonna, and Iodide of Mercury were her reme- 
dies for this year. Early in the next year she began 
to improve mentally; was able to write sensible 
letters, and did not appear to have any delusions. 
She was very anxious to go home; menstruated regu- 
larly, slept well, and had a fair appetite. Her weight 
at this time was one hundred and two pounds. She 
then had a brief depressed period, and indulged in a 
crying spell, for fear she would go crazy again. The 
depression was very brief. In a short time she was 
better and more cheerful. Lilium Tigrinum was the 
remedy administered to quiet her fears about going 
crazy. Five months later she was paroled for a 
month to visit her friends, and at the end of that 


time returned to the hospital voluntarily. She then 
talked sensibly and rationally in every particular, 
and her speech, conduct and self-control were con- 
sistent with perfect mental health. She was then 
discharged from the hospital as fiiUy recovered, just 
ten years from the date of her admission. She has 
remained well since leaving the institution, and is 
now earning her living, as she did before coming to 
the hospital, by teaching music. 

Melancholia vsritb Stupor, or ^^Melancholia At- 
tonita.^^ — This is a somewhat rare disease, but in- 
tensely interesting from the fact that it is con- 
founded with primary dementia, or at least it 
simulates a state of utter mental failure. Besides 
mental depression and mental obfuscation, there 
often exists in the patient thus afflicted a condition 
simulating typhoid fever. Here we have melan- 
cholia, dementia, and fever in a single case. At first 
the claw-hiding paw of unaccustomed sadness is laid 
gently upon the doomed suflFerer, and it is only when 
the capture is assured that the stunning blow of 
dementia falls upon the stricken one, and the sullen 
fever begins its deadly course. In such cases we find, 
first, self-depreciation, coupled with the motionless 
fear of melancholia ; and again, there is embarrass- 
ment of thought, an intellectual inertia, a slowness 
and incompleteness of ideational conception that be- 
longs only to dementia. (M. Baillarger). Thus we 
have a combination of both melancholia and demen- 
tia, a unification so perfect and harmonious as to 
apparently preclude separation. Now in such a dis- 
ease there is likely to arise difficulty in the line of 
making a diagnosis. In short, we must differentiate 
between the new combination (chemically con- 
sidered) and its formative elements. 


Melancholia with stupor may be differentiated 
from primary dementia, ** first, by the expression of 
the countenance, which in melancholia is contracted, 
and marked by an intense although an immovable 
expression ; while in dementia, it is relaxed and ex- 
pressionless. Secondly, in abstracted melancholy 
the patient resists being moved, sleeps badly, and 
often refuses food. In dementia, he complies with 
the wishes of the attendant, has a good appetite, 
and sleeps well. Thirdly, in abstracted melancholy 
the bodily functions are more seriously affected than 
in dementia. The body is emaciated, the complexion 
is sallow, the skin is dry and harsh, and the secre- 
tions generally deranged; whereas in dementia the 
body often retains its plumpness and the secretions 
are little altered from a healthy standard. Fourthly, 
after recovery, the patient who has been affected 
with abstracted melancholy is found to have re- 
tained his consciousness through the whole period of 
his disease. When recovery takes place from pri- 
mary dementia, the past is found to have left no 
traces in the memory.*' (Bucknill & Tuke). Thus 
we distinguish this multiple disease from one of its 
combining forms, i. e., dementia. 

From melancholia we distinguish it by the pri- 
mary intensity of mental anguish, — too deep for 
utterance — and by the subsequent apathy, apparent 
loss of the powers of thought, and utter disinclina- 
tion to all mental and physical action. In the ordi- 
nary forms of melancholia the patient is generally 
able to express himself clearly and cogently, al- 
though he may labor under the delusive idea that 
his soul is lost, or that in the body he is about to 
suffer the pangs of starvation. 

Now in addition to the mental status already 


described as existing in melancholia with stupor, we 
find in some cases a pathological condition of the 
physical system simulating t3rphoid, which both 
complicates the disease and increases its already 
dangerous tendencies. We think that this fever is 
usually the result of personal neglect, the natural 
outgrowth of the profoundly beclouded mental state 
into which the patient has sunk. As a rule, the 
bowels become loaded with a large amount of undis- 
charged fecal matter ; and this, like any other irrita- 
tive foreign substance, induces a slow inflammation 
of the intestinal tract, with a consequent rise of tem- 
perature, and an increased frequency of the pulse. 
Accompanying the fever we have an intensely dry and 
hot skin; a thick, moist and heavily coated, or dry 
and coated tongue ; loss of appetite, with obstinate 
refusal of food, and a somewhat hurried respiration. 
While some of the symptoms, mental and physical, 
simulate typhoid, w^e do not have the exhaustive 
diarrhoea of the latter, nor such a rapid failure of 
the life forces as may occur in zymotic disease. 

During the febrile state of melancholia with 
stupor, which sometimes continues for several 
weeks, the patient is, at times, restless and sleepless^ 
tossing the limbs about, and lying with open eyes, 
yet in a dazed condition; or he appears to be dull 
and comatose, and is aroused with the greatest diffi- 
culty. As a rule, the patient pays no heed to the 
ordinary demands of nature. The urine is either 
retained, requiring persistent removal with a cathe- 
ter, or it is frequently discharged in the bed, thus 
keeping the patient constantly in a wet and un- 
cleanly condition. The bowels are also remarkably 
inactive, and will remain dormant for weeks unless 


their contents are brought away by the use of 

In this strange disease all the machinery of life is 
thrown out of gear ; the smoothness of its workings 
is impaired, and the yIs vitalis is changed to a 
biolytic force, dangerous as dynamite, and whose 
only impulse is to tear down the citadel in which it 
is lodged. And yet it is a disease which may be suc- 
cessfully treated and cured. The patient must be 
artificially fed with a soft rubber catheter through 
the nose. The bowels must be emptied by suitable 
means, and the bladder must be cleared of its con- 
tents at regular intervals, that is, two or three times 
in twenty-four hours. Such remedies as Baptisia, 
Ignatia, and Bryonia may be administered with the 
liquid diet through the nasal tube. 

Melancholia with stupor is, as we have stated^ 
usually ushered in with simple depression of spirits. 
This may occur without previous mental derange- 
ment, or it may ensue in the course of an attack of 
mania. We have had patients brought to the hos- 
pital whose disorders were rapidly and fiiUy devel- 
oped at home under the pressure of some social or 
financial disaster, and, again, we have had others 
who passed into this state after sufifering with other 
forms of insanity for many months. In either case 
we have found melancholia to be the first symptom. 
This, however, is speedily followed by dementia, 
that pitfall which lies at the end of insanity's high- 
way, and which has been fitly termed **the grave of 
the human mind.'' 

Melancholia with stupor may terminate by speedy 
recovery, by absolute dementia, or by death. If the 
patient gets well at all, recovery ordinarily occurs 
within a few weeks, or, at the most, within from two 


to six months from the date of inception. The re- 
covery is often as sudden and unexpected as was the 
onset of the disease. The temperature subsides ; the 
pulse becomes softer and less rapid; the sick one 
sleeps, and awakens to find the stone of sadness 
rolled from the heart, while the soul's recesses, once 
darkened by despair, are again radiant with newly 
received light. 

Profound mental shock may be classed as the 
prime cause of melancholia with stupor. Such 
shocks are most commonly experienced by women 
who are young, of delicate fibre, highly sensitive, 
and extremely emotional in their natures. In such 
persons the play of passion is often of a tragic char- 
acter, and the blighting of affection, the loss of a 
child, or the sudden wreck of a fortune is sometimes 
followed by a benumbing shock, in whose trail 
march the sad sequences we have already enumer- 

Where melancholic stupidity occurs in the course 
of insanity already established, it is difficult to state 
the positive cause, yet even here we believe it to be 
due to some suddenly depressing or exciting emo- 
tion. How far one's natural sensitiveness is re- 
tained, in the ordinary courses of insanity, it is 
difficult to state. Sometimes, however, it is greatly 
increased. With this hypersensitiveness, which we 
often find, it is not at all wonderful that having 
found no relief in the oft-repeated, long-continued 
wail of words, the patient should finally cease to 
speak, "strangle his language in his tears," give 
himself up to utter abstraction, and thus find at 
least temporary respite from his real or imaginary 
troubles. And if the woes of life are not thus 
crushed, the victim may yet hurry on to the Lethe of 


that dull forgetfulness which leaves both hope and 
care behind. The cause of this partial mental pa- 
ralysis lies in the fact that every emotion of joy and 
hope has been chilled by the rude touch of heart- 
breaking disappointment. The mad world is filled 
with the dark clouds of despair, and the most ex- 
alted maniac is at times ** wrapped in dismal think- 
ings," and given over to ** thick-eyed musing and 
cursed melancholy.'' Between this primary depres- 
sion and the succeeding stupor which simulates 
dementia, there is but a single step. The fever comes 
later, but is inevitable unless the patient's bodily 
fanctions are watched and attended to by his 

Melancholia with Agitation. — Over against mel- 
ancholia with stupor we have melancholia w^ith 
agitation, where the person walks, or stands, and 
wrings his hands, and pulls out the hair, and chew^s 
off the finger nails, and picks holes in the skin, and 
moans and groans, and deplores the fate of life. 
Patients suffering with agitated melancholia are 
often greatly distressed over religious matters, and 
such cases are sometimes termed "religious melan- 

Melancholia with Resistance, — This is another 
distressing form of melancholia. Patients suffering 
with this disease resist every attention and care. 
They resist being washed ; they resist having their 
hair combed ; they resist all attempts at dressing or 
undressing; they turn away from their friends, and 
either curl themselves up, hiding their faces in their 
pillows, or they lie straight on their backs, and turn 
away from every one who approaches them. Cases 
of resistive melancholia will often emaciate very 
rapidly, because they refuse to accept proper nour- 


ishment. They also become very filthy, because 
they resist the calls of nature, and are opposed to 
every attempt on the part of the nurses to relieve 
the overloaded bowels and bladder. 

Acute Delirious Melancholia, — This very rare 
form of melancholia has been reported by Charles 
Henry May hew in Vol. I., West Riding Reports. It 
is one of the most formidable diseases which the 
physician is liable to be called upon to treat. There 
exist, in the main, the physical conditions of 
typhoid, or of acute mania, but instead of that 
mental indifiference usually found in severe fever, or 
the reckless exuberance of spirits often noticed in 
mania, there are anxiety, unrest, hopelessness and 
despair. When hope has flown, and corroding care 
supercedes that apathy which is really a conserve^ 
tive force in fever, then, indeed, is the heart sick, and 
life in the last degree jeopardized. It is, therefore, a 
most potent fact that ^*the vital energies are more 
imperiled in cases of delirium where there is men- 
tal depression than in those cases where there is 
mental exaltation.'' The disease, perhaps, depends 
upon a state of septicaemia, or upon some morbid 
poison in the blood, or a disturbance in its constitu- 
tion. As far as I am aware, the blood has never 
been chemically examined in such cases, so that we 
have no information as to whether changes exist in 
its physical properties or composition. The symp- 
toms, however, point to some toxic condition in the 
great nourishing and co-ordinating fluid, producing 
destructive effects throughout the system. The 
febrile condition, the general weakness and uneasi- 
ness which mark the outset of the disease; its sudden 
incursion and quick impUcation of all the secretions 
and excretions; the rapid and extreme expenditure 


of flesh and strength, and the tendency observied in 
some cases to multiple centers of inflammation or 
suppuration, are all compatible with a poisoned 
state of the blood, or the presence in it of effete or 
deleterious matter. That one should suffer the deli- 
rium of despair, under such conditions, is not sur- 

Some one has said that prognosis is materially 
affected in diseases generally by a careful considera- 
tion of the emotional state. On the one hand, we 
find those who are delirious and depressed ; and on 
the other, hilarious and jolly. When a patient 
laughs and frolics, however noisy in language or 
outrageous in conduct, the prognosis may be favor- 
able. It is said that gaiety indicates a reserve force 
which does not exist in cases of depression. Thus 
we see that different types of mental disorder corre- 
spond with different abnormal states, and thus sig- 
nalize with nice precision the progress of patholog- 
ical changes in the brain. It is always well to make 
an analysis of delirious ideas, and to differentiate 
those which tend to anguish, dejection and gloom, 
from those which are buoyed up with hope, exuber- 
ance and joy. Unless you can speedily and abun- 
dantly nourish the emaciated victim of acute deli- 
rious melancholia, and unless you can change and 
stimulate the current of his thoughts, you will be 
likely to lose the case. 

Now for a case or two. Miss E. J. N., aet. 30. 
The certificate of commitment states: **She sits in 
her chair with her mouth wide open, her face fixed 
on vacancy, while the muscles of her face twitch spas- 
modically. Sometimes she tightly closes her teeth 
and lips, refusing to take food or drink, imagining 
that it is poisoned. She refuses to speak ; sometimes 


screams wildly, and is violent." We noticed that 
her hands were tightly clenched, and she resisted 
every attempt at moving her arms. At times she 
seemed to be intensely frightened at some imaginary 
object. On the day following her admission the 
patient was restless and uneasy; her hands were 
moist and constantly clenched; the skin was hot, 
pulse high, temperature about 100. On account of 
her obstinacy, her refusal to eat, and constant 
twitching of the extremities, we gave the patient 
Zincum. For several days she slept but little ; was 
very weak ; failed to pass water, or to have a move- 
ment from the bowels ; did not respond to remedies ; 
and was barely kept alive by the administration of 
beef tea and milk through a soft rubber nasal tube. 
Twelve days later the thermometer in the patient's 
axilla registered 106^^, the pulse about 146, and 
respiration 52 per minute. All indications were 
those of a speedy collapse. At this juncture we pre- 
scribed Baptisia, five drops of the mother tincture in 
half a glass of water, a teaspoonful every half hour. 
In the afternoon an enema was given for the relief of 
the constipation, and a considerable amount of feces 
was discharged. At 9:15 in the evening the tempera- 
ture was 105^^, pulse 140, respiration 46, showing a 
slight change for the better. On the following morn- 
ing the temperature was 104^2^, pulse 120, respira- 
tion much less rapid, skin not so intensely hot as on 
the day previous. The patient's bowels were still 
much bloated and tympanitic. The temperature 
gradually decreased from 104 to 100^% in four days. 
As improvement so happily succeeded its use, 
Baptisia was continued at lengthening intervals. 
Then the patient began to talk. In reply to a ques- 
tion, she said : ** I feel better, but I don't know what 


I am." During the remainder of the month the 
patient continued to gain steadily. This improve- 
ment continued during the next two months, until 
complete recovery was the result of her treatment. 

The foregoing is a severe and typical case of 
melancholia with stupor. One of the best features 
of this class of cases is the fact that under careful 
treatment and good care a large proportion of them 

We now present a typical case of acute delirious, 
melancholia, and, as you will observe, the results 
were quite the opposite from those contained in the 
treatment of a case of melancholia with stupor. 

Mr. H. W. W., set. 54, married, good habits. 
The causes of his insanity were given as heredi- 
tary tendency, business troubles, and worry. His 
father was insane and committed suicide. The dura- 
tion of insanity previously to admission w^as one 
w^eek. While at breakfast one week before admis- 
sion, Mr. W. suddenly threw up his hands and said : 
"I am lost, lost." He was persuaded not to go to 
work that day. The next day he stabbed himself 
about one and a half inches over the left nipple, and 
on the following morning jumped into the river, but 
was rescued. For several weeks previous to this, 
attack he had been unable to sleep, and was 
troubled with dreams when he did sleep. When 
awake he seemed to have a horror of something. He 
thought that because his father was insane he would 
be, and this led to a belief that he would commit a 
terrible crime, for which his soul would be lost. The 
day after admission he wished to go home, as he 
thought that he had no means with which to pay his. 
board. He had no hope, whatever, for himself, and 
was anxious to die. He became excited, noisy, irra- 


tional, and tried to injure himself by striking his head 
against the wall. He accused himself of forgery, of 
ruining people, and of misrepresenting. His pulse 
was 120 ; the skin was hot ; he was intensely rest- 
less, and thought he was about to die. He was 
given Aconite in water. While taking the medicine 
from a tumbler, he bit out a piece and chewed some 
of the glass, but this he was persuaded to spit out. 
He continued sleepless and suicidal, yet he had a 
good appetite for several days. At times he would 
not speak, and on one occasion he stared into 
vacancy without winking for about four minutes by 
the watch. He afterwards became terribly excited ; 
tried to bite himself; was restless, desperate, and 
determined in self-destruction. His tongue was dry, 
pupils moderately dilated, and his appetite began to 
fail. The patient tried so constantly to injure him- 
self by kicking about, that he bruised his ankles and 
knees, and disfigured his arms. At times he would 
yell for considerable periods at the top of his voice. 
At length he began to perspire very freely, and his 
strength failed. When his hands were free he tried 
to tear out his eyes, consequently his hands were 
placed in padded mittens. By reason of his long- 
tiontinued mental and physical excitement, he gradu- 
ally became exhausted and drowsy. He said he was 
all tired out, and yet he slept but moderately. He 
began to experience difficulty in retaining food. His 
tongue was dry and coated; his face pale and ca- 
daverous. He said that he had no pain, but was '* so 
tired." This exhaustion continued until he died, 
just three weeks from the date of admission. 

The temperature in this case was moderate, rang- 
ing from 98 to 101. The pulse was likewise moder- 
ate most of the time, ranging from 72 to 108, and 


only twice rising to 120. The mental agony and the 
physical excitement were absolutely intense, and 
wore out in a short space of time a naturally strong 
and healthy man. The vigor and intensity of his 
mental and physical action might be likened to that 
of a dog suffering with hydrophobia. Such cases 
are almost hopeless, and, with few exceptions, they 
rush themselves into the grave in a very few days. 
There is little or no use in taking such patients to a 
hospital. The jar caused by riding in a car or car- 
riage greatly aggravates their condition. They 
should be kept at home, closely watched, restrained 
in bed, carefally nourished, bathed frequently in hot 
alcohol and water, and the issue patiently awaited. 
Hypochondriacal Melancholia, — Last in the list 
of definite melancholias, we may name hypochondri- 
acal melancholia, or hypochondriasis. This is a 
form of mental disorder where all the thoughts and 
beliefs of the victim are centered upon himself. He 
has the worst liver, the biggest gall, the smallest 
heart, and the most inadequate lungs of any one in 
existence. Such cases are forever reiterating the 
belief that they have an incurable disease ; that they 
are afflicted with cancer ; that their bowels do not 
move ; that the stomach is being filled with innumer- 
able gallons of milk ; that some animal is gnawing 
at their intestines; that the heart is failing to per- 
form its fimctions ; and some of them go so far as to 
think that they are ** going crazy." Now it is prob- 
able that in many cases the hypochondriac is 
afflicted with some fiinctional nerve disorder, which 
causes pain and uneasiness, and which gives rise to 
the exaggerated belief that, there has been some 
wonderfal organic change in the bodily tissues. 
Hypochondriacs should be carefully examined, and 


they should be favored and humored as much as 

The story is told of a woman \srho thought she 
had a frog in her stomach. Her physician finally 
concluded to cure her of this belief, and one day gave 
the patient an emetic, and while she was throwing 
up the contents of her stomach he quietly placed a 
live frog in the bowl w^hich contained the ejecta. 
Upon seeing the frog, the woman was relieved of her 
delusion, but in a short time she said: "Doctor, 
there must be some young frogs in my stomach.'' 
The doctor picked up the frog which he had placed in 
the bowl, and looked at it, and said : ** Madam, that 
is impossible, because this frog is a male.'* Then she 
gave up her delusion entirely. 

So long as the delusion relates simply to a sup- 
posedly diseased condition of the body, there is a fair 
chance for recovery. But if the patient comes to 
believe that there is a ball of fire in the bowels, or 
that an animal is gnawing at the intestines, or that a 
nest of little devils is being hatched out in the womb, 
or that the heart and lungs are being cut out and dis- 
sected for the amusement of the doctors, the chances 
for recovery are very limited. If a person cherishes 
the delusion that he is poverty stricken, and that he 
and his family are coming to want, we regard the 
case as a hopeful one, particularly if the physical 
energies are only moderately exhausted from refusal 
to take food. Those who think they have committed 
a great crime, or the unpardonable sin, do not 
readily yield up their delusions. 

Melancholia, at the outset, does not seem to in- 
volve the intellectual faculties. The victim may talk 
coherently and reason cogently upon all topics ex- 
cept with regard to his dark and deplorable beliefs. 


When patients recover from melancholia they are 
often much happier than they have ever been before. 
They seem to rise to the loftiest heights of exuber- 
ance and enjoy each day of existence, in happy con- 
trast to those desolate periods when they were suf- 
fering most acutely with neuralgia of the soul. 

Prevalence and Prevention 

Melancholia is probably the most prevalent form 
of insanity known to history. Especially since the 
invasion of the grip, we have been burdened with 
numerous cases of mental depression. Almost every 
form of insanity is at times tinged with elements of 
mental depression. General paresis is frequently 
ushered in with an attack of melancholia. The same 
may be said of mania; while hopeless and helpless 
dements sometimes brighten a little, and then, feeling 
their own weakness, sink into the abyss of despond- 
ency on their way back to utter fatuity. 

The prevention of disease is a grander and more 
beneficent achievement than the cure of the gravest 
malady. The surest prophylactic against melan- 
cholia is the leading of a regular, natural and health- 
fiil life, and the moderate and reasonable use of all 
good things with which the earth is so bountifiiUy 
supplied, and which may be had by those who exer- 
cise a proper industry in attaining them. Excess of 
youthful pleasures is always followed by the retribu- 
tion of subsequent despondency. But youthful 
pleasures were designed for wise and noble purposes, 
and should not be utterly avoided. A man who re- 
fuses all good things and becomes an ascetic is in just 
as much danger of drifting into ** innocuous desue- 
tude '' as the glutton is liable to tumble into the pit- 


fall of reckless extravagance. Those who pursue the 
even tenor of their way, and live according to the 
Latin suggestion, in medias res, may never scale the 
loftiest peak which ambition may point out, and 
neither shall they feel the pangs of utter disappoints 
ment when they fail to reach the topmost crag. 

To prevent melancholia you should live patiently 
and regularly, yet withal earnestly, and with a con- 
stant cherishing of good motives and aims of life. 
Thus you may accompUsh an excellent life-work. 
Your destined mission is thus fulfilled, and you will 
be able to smile at Fate, and under every vicissitude 
of life you may be able to say: **I have neither the 
scholar's melancholy, which is ambition; nor the 
musician's, which is fantastical ; nor the courtier's, 
which is proud; nor the soldier's, which is ambi- 
tious; nor the lawyer's, which is politic; nor the 
lady's, which is nice ; nor the lover's, which is all of 

The treatment of melancholia will be considered 
in another lecture, in conjunction with the treat- 
ment of other forms of insanity. 

Pathological States 

The pathological lesions in melancholia are some- 
times difficult to discover— that is, in their finer 
aspects. In a general way it may be stated that a 
passive congestion of the cerebral sinuses is a com- 
mon condition. This congestion acts as a dam, and 
prevents the normal flow of nutritious blood 
through the cortex of the brain. This congestion of 
the venous circulation produces pressure which, if 
unrelieved, leads to atrophy, or wasting of brain 
tissue. In melancholia with excitement there is 


probably an active hyperemia of the brain — a condi- 
tion similar to that existing in acute mania. If the 
melancholy patient is quiet, and indiflFerent to sur- 
roundings or the inception of nourishment, the 
brain may become anemic, and even edematous. 
The nerve cells being unused in a normal way are 
apt to waste in such a manner as to favor the 
hypertrophy of connective brain tissue. Unless the 
brain cells are used in an active and judicious 
manner they will certainly atrophy, and the spaces 
thus rendered vacant will be filled with useless 

In studying the pathology of melancholia, you 
will often find diseased conditions of the abdominal 
viscera, and to such conditions may often be attrib- 
uted much of the mental distress which has invaded 
the life of the individual thus afflicted. In the brain 
itself we often find but slight evidences of disease 
even where the patient has died in his unfortunate 
and depressed state. But even slight pathological 
developments in the brain will sometimes reveal the 
fact that its mental occupant was overborne in a 
most destructive way by forbidden and abhorrent 
forces, until it finally gave up the contest against 
the "slings and arrows of outrageous fortune." 

The track of a vessel, as it disturbs the surface of 
the ocean, is speedily washed away. The casual 
observer sees upon the sunlit billows nothing to pro- 
claim the fact that a steamship has ploughed 
through those obliterating waves. But the keen- 
eyed and long-experienced mariner discovers upon 
the telltale waters oil from the machinery, and 
ashes from the pit, and a bit of sable ribbon torn by 
the winds from a black flag, and he knows from 
these that a stranger and a pirate has passed that 


way. So the phantom bark of melancholia may 
sweep along the sinuses, and glide up and down the 
arterial courses, vexing the shores of the cerebral 
convolutions, yet leaving but little of track or trace 
by which its ravages may be noted or measured. 
Yet skilled investigators, profiting by repeated 
observations, are fast discovering, and marking out 
with faithful hands and by unmistakable signs, the 
course and the character of this unseen but deadly 
enemy of mental health. 



The subject of to-day *s lecture is Mania. The term 
mania, from the Greek fuuvofuu, ^*I am furious," 
means a raving or furious madness. It is used to ex- 
press all forms of intellectual or emotional excite- 
ment where there are exaltations of the mental 
faculties, from distorted impressions and imperfect 
consciousness at the outset, on to disgruntled rea- 
soning powers, dilapidated judgment, disordered 
will, delusions of innumerable types, and hallucina- 
tions of various kinds. 

Incongruity and unnaturalness of thought, 
speech, and action are characteristics of mania ; and 
through all the workings of a thus unbalanced mind 
there run a more or less constant series of impulses 
to works of fiiry and violence. Hence, the term 
mania, a most fitting word to convey the idea of a 
human mind given over to the demon of unrest. In 
a general way, Shakespeare stated the case correctly 
when he wrote: **He foams at the mouth, and by 
and by breaks out to savage violence.'' 

The form of insanity which we shall attempt to 
describe is a favorite form, so to speak, of writers in 
both ancient and modem times. Shakespeare's King 
Lear is one of the best classical models of acute 
mania tending to senile dementia in an imperious 
yet despairing old monarch. We find likewise cases 
of insanity in the writings of Dickens, and Scott, 
and Charles Reade, and Captain Marryatt, and in 


many other works of fiction. In fact, throughout 
all literature, these abnormalities of human nature 
come to the front, and display themselves as fasci- 
nating fantasticals in the solemn procession of real 
or fictitious life. 


The causes of mania are put down in the books 
under such heads as loss of property , mental anxiety, 
overwork, illhealth, injury to the brain, sunstroke, 
and many other expressions which denote that the 
victim has experienced during his earthly sojourn 
some unfortunate disaster in mind, in body, or in 

The general causes of mania are much the same 
as those which produce melancholia. In the latter, 
however, the shock w^hich produced the disorder 
works in such a way as to cause depression, while in 
mania the causes of mental injury tend to the pro- 
duction of irritation and of excitement. In demen- 
tia, the causes of insanity tend to bodily exhaustion 
and mental failure, while in general paresis the shock 
of disease comes after long and unwise contact with 
worry, wine, and women. Perhaps the tempera- 
ment of the individual determines, to a large extent, 
the form of insanity which will crop out in a given 
case. In the production of artificial insanity by the 
use of stimulants, you will find that some men be- 
come depressed after drinking ; others become hilari- 
ous, boisterous, noisy, and pugilistic; others sink 
into the fatuous and besotted state of dementia; 
and again, others simulate general paresis by the 
development of a general tremulousness, a tottering 
gait, a relaxed and unmanageable tongue, and a 
heightened imagination. 


The physical causes may embrace every possible 
disease of the brain, from a primary congestion to a 
terminal lesion of the substance itself. In searching 
for the physical causes of mania, we must examine 
the head, the thorax, and the abdomen. Likewise 
we should consider the state of the sexual organs, 
for diseases of the uterus and ovaries, with irregular 
and suppressed menstruation, often accompany an 
attack of severe mania. 

Mania often follows in the wake of general fevers, 
and their exhausting and irritating effects upon the 
nervous system must receive a proper consideration. 
Suppression of the normal excretions of the body 
may sometimes result in a maniacal attack. Long- 
continued illhealth, together with worry, and anx- 
iety, and perplexity, and apprehensions of various 
sorts, may tend to develop at first a general irri- 
tability, and afterwards an exaltation of the mental 
faculties that passes beyond the limits of ordinary 

Insufficient sleep is one of the greatest dangers to 
mental health. The habit of getting up too early in 
the morning is generally the offspring of necessity. 
Those who are poor, and who are obliged to work 
hard for a living, must, as a rule, by compulsion rise 
early in the morning. By too early rising, I mean 
the getting up of these unfortunate victims of cir- 
cumstance before the mental and physical forces are 
thoroughly recuperated from the exhaustions and 
trials of the day before. This danger of early rising 
comes not only to the farming classes, but likewise 
to those who labor in the mills, and factories, and 
stores of the cities. The gentleman of fortune and 
the unworrying tramp are usually free from the dan- 
ger of getting up too early in the morning, and are 


comparatively free from the invasion of insanity. 
To avoid the 'danger of too early rising, the work- 
ing classes should retire as early as possible in 
the evening, in order to devote at least eight hours 
to rest, and physical and mental refreshment. The 
trouble with many is that they sit up late for 
purposes of amusement or through the necessity for 
toil, and then get up in the morning before they are 
fally refreshed by sleep. 

In a general way, we may state that mania may 
result from any unusual shock or strain upon the 
nervous system ; or it may come after any unusual 
mental excitement in business, in politics, or in 

Now, while we may easily recognize some of the 
exciting or stimulating causes of mania as affecting 
immediately the individual, I think we must go back 
of the presence of worldly misfortune, and trace the 
tendency to mental disorder through channels of 
hereditary influence. No one doubts the fact of 
resemblance in families of face and figure. How, 
then, can we doubt the fact of inborn tendencies to 
either mental steadiness or mental eccentricity? 
There are those whose natural bent is toward inco- 
herency of thought and action. Infants are bom 
every day whose inevitable goal is that of insanity. 
The toxic influence of wrong-living and wrong-think- 
ing pervades their w^hole being while yet occupying 
a chaotic residence in their father's loins. 

The primary and subtle causes of maniacal excite- 
ment should be careftilly studied and understood by 
those who are to become physicians and teachers in 
the world at large. The physician's advice should 
be sought in every case of prospective marriage. By 
restraining those who are unqualified for the duties 


and responsibilities of propagating their kind, we 
might, after a time, improve the temper and quality 
of the human race. Correct methods of living 
should be learned from wise doctors, and thus the 
preparation in early life for future marital duties 
may be made. 

Lack of brain poise, brain strength, and brain 
soundness at the outset, and lack of suitable mental 
culture subsequently, are, we believe, the most pro- 
found causes of this intellectual aberration known 
to the profession under the significant title of mania. 
These causes are but rarely recognized, and still 
more rarely acknowledged. How much easier it is 
to tell the mother that her daughter has become 
insane through some real or fancied sUght put upon 
her affections, than it is to say: ** Through your 
own carelessness and wrong-living your child was 
bom with a badly constructed brain." How much 
more popular is that physician who declares that 
the young man has studied too hard or worked too 
much, than is the medical adviser w^ho, seeking the 
real cause, plainly states that the brain of the victim 
was bent at the outset, and never straightened by 
judicious fostering in youth. 


The variety of insanity known as mania has 
numerous forms which we shall classify as follows : 

1. General forms, — namely, acute, subacute (par- 
anoia), and chronic. 

2. Special forms, — ^namely, acute delirious, recur- 
rent, periodic, and circular. 

3. Peculiar forms named from supposed causa- 
tion; to wit, traumatic, masturbatic, syphilitic, 


puerperal, hysterical, climacteric, tubercular, meta- 
static, and post febrile manias. 

4. Disputed forms, such as monomania and 
moral mania. 

5. There is also a class of manias which may be 
designated by some peculiar sin or crime, such as 
dipsomania, erotomania, nymphomania in women, 
satyriasis in men, kleptomania, pyromania, etc. 

Symptoms, Courses and Cases 

We will now invite your attention to a considera- 
tion of the symptoms and courses of those manias 
classified under the head of "general." The others 
will, by their names, denote their tendencies, 
although we shall again refer to the most important 
of them. 

Acute Mania. — Acute mania is usually preceded 
by a period of mental depression. This depression is 
accompanied by a disposition to brood upon a 
single, all-absorbing topic. Dr. Johnson, the great 
English moralist, in his famous work entitled 
**Rasselas,"has traced with a master-hand the slow, 
sinuous advances of mental derangement. He says : 
**Some particular train of ideas fixes the attention; 
all other intellectual gratifications are rejected ; the 
mind, in weariness or leisure, recurs constantly to 
the favorite conception, and feasts on the luscious 
falsehood, w^henever she is offended w^ith the bitter- 
ness of truth. By degrees the reign of fancy is con- 
firmed ; she grows first imperious, and in time des- 
potic. Then fictions begin to operate as realities, 
false opinions fasten upon the mind, and life passes 
in dreams of rapture or of anguish. '* 

Struggling against these ill-defined and misty 
influences, the patient feels painfully the slow 


gatherings of an unseen storm. He becomes anxious 
and apprehensive, \srakeftil and haggard. A sense 
of intolerable unrest pervades his entire being ; yet 
he may for a time be able to conceal these sensations 
from his most intimate friends by calling to his aid 
all the reserve forces of self-control. Gradually sleep- 
lessness occurs, and the appetite becomes capricious 
and irregular. Dark, gloomy thoughts pervade the 
mind even as damp vapors infest the valleys. Delu- 
sions which he cannot banish creep in. The victim 
thinks himself followed, and turns often to look at 
his pursuers. He imagines that his life-long friends 
are failing him. He begins to suspect that his food 
is being drugged; that the medicine which he may 
be taking for some bodily ill is potent poison ; that 
he is being practiced upon by electricity; that the 
air is full of baleftil odors. Charged with these false 
beliefs his mind becomes a pent-up volcano, ready to 
belch forth at the slightest provocation. The whole 
current of life thus becomes gradually changed. The 
victim's daily toil becomes a burden. Social pleas- 
ures lose their fascination. The coming patient is 
given over to seclusion and brooding. The slightest 
cross to his wishes provokes him to fits of anger. 
The least anxiety induces an ebullition of rage. He 
neglects himself and becomes shabby in person. He 
ceases to care for his family, and is inclined both to 
jealousy and hatred of those who were formerly 
dearer than life. Finally the great upheaval comes. 
The bonds of propriety are suddenly snapped 
asunder. The patient yields himself up to his delu- 
sions, and is by them impelled to the commission of 
the seven deadly sins. No description is adequate to 
the practical reality. Honest men are transformed 
into demons, ready for any criminal act. Pure 



women become shameless, obscene, hideous. Mania 
is human nature unmasked and unrestrained. It is 
a condition which shows up in lurid light all the 
depths of total depravity. As mania develops in the 
patient, wild, incoherent, bubbling monstrosities of 
thought are begotten in the brain. These make 
their presence manifest by impelling the sick man to 
loquacious and unchecked babble. Incongruous as 
each remark may seem to its precedent, there yet 
runs a thread of continuity through the whole mass 
of illogical reasoning, just as a red thread runs 
through all the cordage of the British Navy. There 
is a certain fixedness of ideas in spite of irregular 
modes of expression. Each day brings a repetition 
of the same thought, but often with original 
rhetoric. Thus we observe truth in the classical 
statement that there is method in the madman's 

The physical condition in a case of acute mania 
simulates, somewhat, the middle course of t3rphoid 
fever, although there is less rapid failure of the life 
forces. Where the mania is long established, the 
appetite of the patient generally becomes good, and, 
in fact, oftentimes it is ravenous. By the consump- 
tion of large quantities of food the bodily strength 
is greatly conserved. 

Mania is a disease where daily and nightly phy- 
sical and mental restlessness may be expected. In 
typhoid fever while the patient is restless he is also 
prostrated, and can usually be kept in bed. The 
maniacal patient, in many instances, can be retained 
in a recumbent position only with considerable diffi- 
culty. Typhoid fever usually runs its course in 
about three or four weeks. In mania, the patient 
may continue in a state of profound excitement for 


many months. The skin is commonly hot and dry, 
with now and then a light, or sometimes a profuse 
perspiration. The tongue at the outset is somewhat 
coated with a yellow or yellowish-brown coating, 
and the breath is indescribably offensive. 

If mania progresses with marked severity, the 
tongue becomes red at the top and edges, and in fact 
is often red throughout, with a tendency to get 
parched and brown. The lips are frequently dark 
and cracked, and there may be sordes upon the 
teeth. The face is drawn and haggard; the lines 
of intelligence deepen; there is a scowl upon the 
forehead, and the eyes are wild and glaring. The 
pupils are generally dilated, though occasionally 
contracted ; the pulse is somewhat quickened, and is 
hard and wiry. It feels harder than the pulse of 
ordinary fever. Occasionally the pulse feels like a 
writhing whip-cord under the fingers. This is due to 
the intensity of the heart's action, yet the tempera- 
ture in such a case is but moderately elevated. 

While the victims of mania often eat well, there 
are some cases where eating is neglected, and where 
the patient might starve through inattention. It is 
the duty, therefore, of the physician and the nurse to 
see that such patients are sufficiently fed. The 
bowels are frequently inactive. The feces become 
hard, and are discharged with difficulty. It is not 
always easy to get a case of mania to pay proper 
attention to the calls of nature. Thus tremendous 
constipations sometimes arise. They may be relieved 
by injections of warm oil. Ten or fifteen drops of 
the mother tincture of Hydrastis may be added to 
from four to six ounces of sweet oil, and that makes 
a satisfactory injection for a bad constipation. The 


urine in mania is high-colored, often scanty, and 
loaded with phosphates and urea. 

The mania case is often dirty, lewd, and quarrel- 
some. Some patients will eat their feces, and drink 
their urine, or smear the body and the room with 
the same. Some seek constantly to breed turmoil 
about them. They grossly assault those who are 
endeavoring to care for them, and if restricted, will 
complain of their treatment. Maniacal patients 
frequently bury the hatchet of truth, and dig it up 
again only when their reason is restored. 

The course of acute mania ranges from one to six 
or more months. The length of time it may last 
depends upon many circumstances, — ^upon the age, 
sex, cause, period of incubation, number of previous 
attacks, and other conditions. It is never safe to 
predict a time at which an attack of mania will ter- 
minate. The disease has no certain or probable 
course. If it is a first attack, and the victim is 
young and of good physique, with a tolerably 
healthy family history ; and if the patient has elastic 
spirits, and is readily impressed by favorable influ- 
ences, the prediction of recovery may be limited, 
with approximate accuracy, to from three to six 
months. But since most of these cases are burdened 
with complications, it is unsafe to make any positive 

The following is a typical case of acute mania, 
together with the results attained by treatment : 

Mr. H. came to the hospital with a history of hav- 
ing been excited recently at some religious meetings, 
which, with suspected masturbation, was assigned 
as the cause of his attack. He was of effeminate 
-appearance, single, thirty-five years of age, and con- 
sidered a careful and economical business man. Two 


weeks before coming here he became flighty ; bought 
things he did not need ; had the idea that he was 
Christ; that he could cure all ills, raise the dead, 
produce magical growth of plants, or do anything 
else that occurred to his mind. He talked inces- 
santly of these and other things, and as his ideas 
flowed faster and faster, his tongue became unable to 
keep up, and his words ceased to bear any coherent 
meaning. He had hallucinations of sight and hear- 
ing, and conversed by means of his soul with people 
not present. For two and a half months he was 
restless, talkative and destructive. Only now and 
then could any of his remarks be interpreted into 
anything like reason, yet his conversation was in- 
fluenced by what occurred about him. He was often 
twenty-four hours without sleep, and in spite of an 
abundant nourishing liquid diet his weight fell off". 
Toward the end of this period, short intervals of 
calm occurred from time to time, to be followed in a 
few moments or hours by a full return of the mania. 
Then he became quiet, unless spoken to, when his 
speech, after a few minutes, would become confused, 
and this in turn passed away with the progressing 
convalescence of his mind. Meanwhile his weight 
increased; his color improved; he took an interest 
in the life around him ; his cleanly personal habits 
returned, and five months after his admission he left 
the institution a well man. His remedies were Bella- 
donna, Avena Sativa, Cannabis Indica, Arsenicum, 
Hellebore, Stramonium^ and Hyoscyamus. 

Among singular cases of acute mania I may give 
the following : 

A boy, eleven years of age, while passing through 
a forest on his homeward way from school, per- 
ceived a wildcat, and heard that animaVs blood- 


curdling scream. He ran home in g^eat terror. He 
rallied from the shock, only to pass into a state of 
exaltation amounting to acute mania. The child 
was committed to the Middletown State Homeo- 
pathic Hospital. Shortly afterward his two young 
sisters, aged eight and nine, who had witnessed his 
convulsive and maniacal outbursts, were similarly 
affected, experiencing attacks of acute mania, and 
were likewise committed to the hospital. All of the 
children quickly recovered. While they were in our 
charge it was necessary to keep them in separate 
buildings for a time, that they might not see one an- 
other, and thus suffer injurious excitement. When 
considerably improved, they could associate with 
one another without detriment. 

Subacute Mania, — This is a mild but somewhat 
persistent form of mania. The patient does not suf- 
fer from those violent outbursts of passion, or long- 
continued paroxysms of excitement so characteristic 
of acute mania, but he cherishes the same general 
delusions, and possesses, in a mild degree, the same 
physical and mental peculiarities. The subacute 
mania patient is cunning, self-poised, and deceitful; 
and will often induce in the minds of the unwary the 
conviction that he is not insane. When, however, 
you touch upon his chief hobby, he becomes aglow 
with suppressed excitement, which is most fre- 
quently manifested by a certain muscular tremor of 
the body, a hurriedness of speech, and an unsteadi- 
ness of the voice like a person laboring under the ef- 
fects of but partially restrained passion. At the 
same time a glaring brightness of the eye is also ap- 
parent. Such cases often fancy that every man's 
hand is against them, and hence are exceedingly 
jealous of their rights. These are the patients who 


are always threatening to sue the hospital for 
damages, who are constantly plotting to escape, or 
who seek liberty by means of the habeas corpus. 
They not infrequently deceive a jury of the laity by 
their shrewd deceptions and apparent lucidity and 
cogency of reasoning. These cases are generally 
cleanly, bright, apparently cheerful, and while re- 
tained in a hospital keep themselves under good self- 
control. But their deceitfulness, tyranny over 
friends, and unchecked impulses to wreak revenge for 
fancied slights when at large, call loudly for proper 
care, restraint and treatment. 

Paranoia. — This term is derived from two Greek 
words, Trapd, "beyond," and, voew, "to know or to 
understand.*' It is a subacute form of mental ex- 
citement characterized by delusions of persecution 
and wrong. It is really a form of subacute mania. 
The delusions are fixed and systematized, and do not 
readily yield to any form of treatment. Paranoia is 
usually the outgrowth of a high grade of imbecility. 
Paranoiac 'patients come very near being wise, and 
some would be able to carry in their minds a little 
wisdom if they were not so horribly overburdened 
with conceit. 

"The delusions of the paranoiac may be reduced 
to two, giving rise to the two recognized forms of 
the disease, viz.: 

1. Paranoia, with delusions of persecution, 

2. Paranoia, with delusions of ambition or 

The latter has been subdivided into : 

(a) Religious paranoia, 

(b) Erotic paranoia, 

(c ) Jealous paranoia, etc. 

Delusions of persecution and grandeur may be as- 

^ I 


sociated primarily, or the ambitious delusion may 
arise as a logical outcome and explanation of the 
delusion of persecution. He believes he is persecuted, 
therefore he must be great; or he believes he is 
great, hence his persecutions. In either case his 
greatness is assured, and his supposed persecutions 
explained. His hallucinations do not by any means 
always confirm his belief in his greatness, but if not 
they usually add to his persecution. He hears vile 
names applied to him, people on the streets mock at 
him, the cough or sneeze of a passer-by is a signal of 
his enemies, and means harm to him ; therefore, he 
argues that he is a person of importance of whom 
others are envious, and whom self-interest impels to 
compass his sufi*ering and death. If he lives in a 
monarchy some fancied resemblance to the reigning 
family leads him to believe that he is of royal blood, 
and thus an explanation is famished which satis- 
factorily accounts for his persecutions, and at the 
same time flatters his egotism and self-love." 
(George Allen, M. D.) 

If these patients begin to cherish delusions in 
early life, and cling to them systematically for years, 
they are not likely to recover. Sometimes if the 
delusions develop later in life, and the patients are 
favored with proper treatment at an early stage, 
they may get well, or get enough better to become 
quiet and useful citizens. 

The following case from the hospital records is 
given as illustrative of paranoia : 

A. v., a captain in the civil war, wounded in the 
leg at Gettysburg, while fighting desperately after 
most of his men had left the field, was bom sixty-eight 
years ago in Germany. He is a man who always 
fully appreciated himself. He was wounded in trying 


to hold a position after he had been ordered to re- 
tire. His own opinions, activities and accomplish- 
nients have ever seemed to him of prime importance. 
In his younger days he was able to keep them in the 
background, but after years of secret brooding over 
w^hat seemed slights and insults, his self-esteem be- 
came morbid, and delusions of persecution de- 
veloped. He considers himself the most learned man 
alive, and spends hours every day in committing his 
theories to manuscript. He is a believer in evolution, 
and declares that by finding a prototype of the 
female hymen in a Florida fish, he has supplied the 
cap-stone of proof; and this is only one of his many 
pseudo-scientific discoveries. Before being committed 
to a hospital for the insane he thought Mr. Cleve- 
land, then president, stole his w^ar record, and hid it 
in the White House, where he proposed to find it by 
a personal search; and he ascribes his confinement 
since then to continuous persecution in the hands of 
powerful politicians. Still hope never deserts him; 
such a man as he is cannot be downed ; and when 
excited he regales his caretakers with promises of 
chains and tortures when his friends, whom he has 
summoned by his wireless telegraphy, shall come 
with avenging hands to the rescue. At ordinary 
times he is a quiet, gentlemanly old man, with a pen- 
chant for making himself believe that young lady 
employees are detained here involuntarily, and that 
he is a knight-errant whose mission is to effect their 
release. He refuses to take medicine, because he 
thinks he does not need any. The medicine which 
was presented to him he pronounces atropine, and 
he is carefully keeping it to prove a conspiracy to 
take his life by poison. 

Chronic Mania. — Chronic mania is that form of 


insanity where the mental disorder has continued 
for a considerable length of time. The term chronic 
insanity, is a somewhat arbitrary term. The word 
*' chronic" is derived from the Greek, ^ovfn^^ which 
means "time." Consequently when we speak of 
chronic insanity, we mean an insanity which has 
continued for some definite or indefinite period. 
Some writers claim that a case of insanity may 
properly be called chronic after the disease has con- 
tinued for a period of two years. Others deem those 
patients chronic who have been insane more than 
one year. The distinction is an arbitrary one, and 
liable to excite discussion. For practical purposes, I 
think we may call cases of insanity chronic after the 
disorder has continued steadily for a period of two 
years or more. 

Chronic mania may terminate by running into 
dementia, by death, or occasionally by recovery. 
Dr. Rush says that "spontaneous recoveries now 
and then occur after the disease has continued 
eighteen or twenty years." (Aphorisms in Rush on 
Mental Diseases). Dr. Clouston, with regard to 
prognosis in mania, says: "Where there is exalta- 
tion, there is hope. We do not pronounce a case 
incurable for a long time; so long, in fact, as the 
morbid brain exaltation lasts, and dementia does 
not supervene. Concerning all cases of mania, so 
long as intellectual activity continues, and mental 
failure is not established, we should continue treat- 
ment with a view to recovery." Nearly all cases of 
mania may be classified as either acute, subacute, or 

The delusions of the chronic insane, though 
cherished with tenacity, are generally modified or 
toned down from the acute or subacute form. Some 


of them are of a most curiotis nature. One of our 
patients cherishes the sincere belief that she is an 
^*atom of dust," and ridicules herself for speaking, or 
eating, or performing any of the ordinary acts of life. 
Another claims that she has not been born, and says 
that her head is on fire. Still another can never get 
the words right, and works herself into a frenzy over 
words which get "all mixed up,'* according to her 
delusion. This patient thinks at times that the 
letters of the alphabet are all turned into s's and z'z, 
and that it will take a lifetime to get them straight 
again ; yet she always talks correctly, answers ques- 
tions promptly and clearly, and is finely educated. 
Another patient has for years persisted each day of 
her life that she ** never stole Charlie Ross," and 
^' never burned Chicago." Mrs. A. says she is "the 
Saviour and the Judge of the quick and the dead." 
Mrs. C. thinks she is fed with bread from heaven, 
and water from the rock. These are brought to her 
daily by birds with tinsel wings. 

The insane man usually thinks that all things 
center in himself. He is the hub of the universe, and 
thinks and talks as if he were the only person 
worthy of consideration on earth. Many of the in- 
sane are egotistical. They do not fraternize well 
with one another. They rarely listen to the de- 
lusions of others, but prefer to consider and repeat 
their own. 

Special Forms 

Acute Delirious Mania. — Here we have an intensi- 
fied form of acute mania accompanied by delirium, 
and terminating ordinarily in exhaustion and death. 
A diagnosis of this disease is not always easy, since 
many times it bears a striking similarity to acute 

^ I 


mania. We may be guided, however, by the temper- 
ature, which is higher in acute delirious than in 
simple acute mania. The inception of this disease is 
generally sudden, and the outbursts of fury are 
severe and appalling. There are occasional remis- 
sions of excitement, but they are simply lulls in the 
storm, during which the tempestuous forces gather 
renewed strength. The disease is marked by two 
stages: First, excitement; and second, collapse. 
During the first period the face of the patient wears 
a peculiar expression which has been described as ** a 
mixture of incredulity and maliciousness." The eyes 
are brilliant and glaring, and roll about with great 
mobility in their sockets. The mouth is filled with 
tenacious spittle ; the lips and teeth are covered with 
sordes; the tongue is dry and generally coated 
brown, or it may be clean and bright red. The 
patient will often grind his teeth for hours in succes- 
sion (also general paresis), and he frequently mani- 
fests a strong aversion to liquids. Sometimes when 
hurriedly taking a drink, he w^ill bite a piece out of a 
heavy tumbler as if it w^ere a cracker, and will chew 
up the glass as readily as a boy can eat a candy 
chip. The skin is dry and hot, and imparts a burn- 
ing sensation to the hand. The patient keeps up an 
almost continual motion. Frequently the hands are 
kept moving in circles about the head. Hallucina- 
tions of sight are commonly present, and the patient 
often addresses some imaginary individual. Con- 
stant and protracted sleeplessness almost always 

The prognosis in this form of mania is generally 
unfavorable. In this respect the disease differs from 
both acute mania and typhoid fever. The stage of 
collapse comes suddenly, and is almost always very 


brief. Now and then a case recovers, but this occurs 
only when the disease is recognized at the outset, and 
when prompt measures for relief are adopted. The 
life forces must be conserved by judicious care, and 
easily digested nourishment, and the administration 
of carefully selected remedies. 

Recurrent Mania, — In this form of mania the 
patient is very excitable for a time, and then appears 
to have a full remission of all symptoms of insanity • 
But the invasions of disease are repeated at inter- 
vals, varying in frequency from one month to two or 
more years. A case is on record (but not at this 
hospital) of a woman who recovered from recurrent 
mania forty-seven times, and who finally died 
during the forty-eighth attack. 

Periodic Mania, — This is a subdivision of recur- 
rent mania. It is named periodic from the fact that 
the outbursts of violence recur uniformly at stated 
periods, as every month, or every summer, or every 
winter, or in the case of some females at every men- 
strual flux. 

Circular Mania, — Circular mania is a rhythmical 
alternation of mania with melancholia. Sometimes 
between the extremes of exaltation and depression, 
there is a period of complete remission or recovery. 
An interesting case of circular mania was long under 
my personal observation. The case was that of a 
lady patient at the hospital under my charge who 
for years lived in the following manner: For four 
weeks she would lie passively in bed, and no induce- 
ment whatever could arouse her to any physical or 
mental action. During this period she was much 
depressed in mind, would scarcely speak, answered 
questions only in monosyllables, and ate sparingly, 
but slept a good deal. At the end of each period of 


decubitus she would brighten up, have an improved 
appetite, become cheerful and talkative, and on the 
day following the completion of this month of rest 
she would leave her bed, dress and appear upon 
the hall the most loquacious of women, the most 
ceaseless in physical activity, and the most impe- 
rious in her numberless demands. At times she 
would become intensely excited, obstinate and mis- 
chievous. During the winter season she was much 
more inclined to violence than during the warm and 
pleasant summer months. 

Peculiar Forms 


Traumatic Mania, — Among peculiar forms of ma- 
nia we have the traumatic form. In the cases which 
have come under our observation, we have noticed 
that the leading characteristics are restlessness, in- 
coherence, vivid hallucinations, mistaken identities, 
muscular weakness, heat in the head, and at times a 
besotted, half-drunken, dazed expression of the 
countenance. As to the pathological states in trau- 
matic insanity. Dr. Skae holds that there is a chronic 
hyperemia of the brain and its membranes ; while Dr. 
Blandford asserts that we have **to deal with a mi- 
nute molecular change — a change which may be due 
to contusion of the gray matter, caused by a blow 
or a fall, and producing an alteration in nourishment 
and growth of the part, in blood supply, or in the 
nerves presiding over it.'' 

Clouston states that he has seen about twelve 
cases of traumatic insanity in nine years ; and con- 
cludes therefore that ** accidents to the head do not 
loom largely in the production of the insanity of the 
world." J. Crichton Browne, on the other hand, 
suggests that brain injuries, inducing insanity, occur 


at all periods of life, from forceps deliveries to the 
accidents of old age. We believe that many of the 
brain injuries sustained during childhood are for- 
gotten ; and consequently when insanity occurs, this 
subtle and remote cause does not figure in the 
history of the case ; and in old age these injuries are 
concealed by the pride of the victim. After a careful 
inquiry as to the general experience of numerous 
patients, we have come to the conclusion that many 
insanities properly date their inception from a blow 
upon the head, inflicted during the growing and 
tender, or later periods of life, and resulting in 
minute and long-continued pathological changes in 
the brain. Almost all cases of epileptic mania are 
aggravated by brain injuries which arise from the 
tendencies of the primary disease. 

We present a case of mental disease produced by 
direct injury to the brain ; and likewise a case whose 
recovery dates from an accidental but severe blow 
upon the head. Thus we have what may be called 
traumatic insanities, and traumatic recoveries. 

The first case is number 2,207. Mr. W. E. S., aet. 
18 ; occupation, laborer ; education, common school ; 
habits, temperate; no record of insanity in the 
family. When admitted the patient was in good 
physical condition, and his history declared that 
down to the date of his injury he had been a bright 

About six weeks previous to his admission to the 
the hospital, Mr. S., while standing on the top of a 
ladder, twenty-six feet in length, picking apples 
from a tree, fell to the ground, striking on the back 
of his head. He was carried into the house uncon- 
scious, and remained so for several hours. He re- 
ntiained in bed only one day. From the time of his 


axicident to the time of his admission, he is said to 
have spoken but two or three words. He could 
not speak when admitted, but during his entire ill- 
ness he was able to comprehend questions written 
upon paper, and would answer these questions 
readily and rationally in writing. In his writings 
he stated that all spoken words sounded like noises 
to him, but had no meaning. He could hear a low 
tone of voice, but not a whisper. In writing answers 
to questions, he did so quickly, and showed a clear 
comprehension. He asked questions intelligently by 
writing, and said that he had a dull, steady pain 
from the base of the brain down the spine to the 
small of his back, and this pain was aggravated by 
any sudden jar. On examination, the spine from the 
first lumbar vertebra to the skull was found to be 
very sensitive to touch and pressure. He said that 
exercise did not tire him, and for several weeks he 
was allowed to do as he pleased. He spent much of 
his time out-of-doors playing with a large New- 
foundland dog which was much attached to him^ 
and which attended him when he came to the hos- 

Five days previous to his admission to the insti- 
tution, this patient became much enraged at his 
mother who would not grant some request he made^ 
and he flourished a long knife and tried to injure her. 
On being shut up in a room he broke the door and 
was very violent. His friends then had him com- 
mitted to the hospital under my charge. When 
admitted, his pupils were normal in size, and the 
reaction was natural. The tongue was clean and 
firm, with no muscular tremor ; the pulse was 78 ; 
the temperature 98.4°P. The patient weighed 150 
pounds, and seemed generally in good physical state. 


He had a good appetite, slept well at night, stated 
in writing that the pain in his head had ceased, and 
he deported himself like a bright, good-natured, 
active boy. But he could not hear distinctly, and he 
could not speak at all, although apparently compre- 
hending everything that was written and placed 
before him. 

Here was a case of motor aphasia, or aphemia 
-(can write but cannot speak), resulting from a blow 
upon the head, with occasional attacks of maniacal 
excitement; the excitement being displayed by rest- 
lessness and ebullitions of rage, without any ability 
to give articular utterance to his emotions or pas- 

Although the patient had been allowed to walk 
about as much as he pleased for nearly six weeks, we 
concluded it would be better for him to remain quiet. 
Consequently we placed him in bed, and kept him 
there. The second day after admission he caught 
<:old, and wrote on paper that his head hurt when he 
coughed. Four days later, about 9 a. m. — he wrote 
on a slip of paper, "headache," and gave it to the 
attendant. About 11 a. m. the pain in the head had 
increased, and at 11:30 a. m. he was rocking back- 
ward and forward in bed with both hands pressed 
tightly against his head, one being over the forehead, 
the other over the occiput and upon the seat of 
injury. His face was flushed, pupils dilated, and the 
eyes deeply injected. While an assistant physician 
was noting these symptoms, the patient suddenly 
removed his hands from his head, looked up like a 
person awaking from sleep, gazed about the room in 
an inquiring manner, turned to the window, looked 
out for a moment, then suddenly turning to the 
-doctor he said : " Where in the devil am I ?" These 


were the first coherent words uttered since the in- 
jury. This patient's mind went back to its normal 
position with a snap, so to speak, just as a dis- 
located bone returns to its socket when it is set by a 
surgeon. On being asked if he did not know where 
he was, he said: **Not in the least. I know I was 
picking apples when the ladder broke and I fell, 
striking on the back of my head. Oh, how it hurt!" 
On being told that it was some weeks since the acci- 
dent, and that he was in a hospital, he said : ** Why, 
that was the eighth of October, what day of the 
month is it now?" On being told that it was the 
twenty-third of November, he replied: "To-morrow 
will be Thanksgiving Day; a lunatic asylum is a 
queer place to pass Thanksgiving Day." When told 
that he had not spoken before since coming to the 
hospital, he said: **I must have been good com- 
pany." On questioning him he declared that he had 
no memory of anything that had taken place since 
his fall from the ladder. For six weeks, time had 
been a blank to him. After he began to talk, his 
headache lessened. He was kept quietly in bed, and 
given hot milk and beef tea every three hours. The 
headache and tenderness along the spine soon passed 
away, and no symptoms of brain or mind trouble 
returned. He remained at the hospital under obser- 
vation for three months, when he went home in ex- 
cellent physical and mental condition. While his 
memory was dislocated for six weeks, he could, after 
his recovery, remember distinctly all the previous 
experiences of his life, and all new experiences, but he 
could never recall any incident that occurred during 
the six weeks mentioned. 

The second case is No. 356. Mr. J. A. H., 24 
years of age ; occupation, clerk ; education, common 


school ; no insanity in family. He was suflfering with 
the seventh attack of mania. He had been insane 
(daring his last attack) about three or four weeks 
previous to his admission to the hospital at Middle- 
town. He had been in other hospitals six times, and 
each hospital visit had lasted from three to eighteen 
months. On admission he was noisy and restless. 
The first night he did not sleep, but devoted his 
energies to tearing up his clothes. He admitted that 
he was addicted to masturbation. 

The second day after admission Mr. H. was tear- 
ing his clothes, talking loudly, and eating soap 
whenever he had an opportunity. At three p. m. he 
tried to swing on a gas fixture in a wash-room, and 
turn a somersault through his hands; but as he 
swung his feet up to his hands, the gas fixture broke 
and he fell, striking his head and shoulders upon a 
tile floor. He got up, walked about, and talked for 
twenty minutes afterwards, when he became sud- 
denly unconscious. His breathing was stertorous; 
his pulse 80 and very strong; his pupils appeared 
about normal in size. Soon after he became uncon- 
scious, the face grew purple in color, and the muscles 
of the right side of the mouth twitched ; the pupils 
were insensible to light; the eyeballs insensible to 
touch, and there was diverging strabismus. At 4:30 
p. M. the right pupil was more contracted than the 
left. At 6 p. M. the pupils were normal ; the pulse 80. 
The patient was groaning, and he spoke confusedly 
of feehng badly in the left groin. At 9:15 p. m. the 
pulse was 72 ; the urine had been passed freely ; the 
patient was very drowsy, with occasional muttering 
delirium. On the following day the pupils appeared 
normal ; the pulse was 80 ; the urine and feces were 
voided with difficulty ; the patient was able to talk,, 


and complained of headache in the top of the head. 
He slept most of the time that day. The next day he 
seemed to have recovered very largely from the 
effects of the fall, and on the following day, three 
days after the injury, he talked and acted sensibly ; 
and he continued to do so as long as he remained 
under our observation. He remained willingly at 
the hospital for about two months from the date of 
admission, when he was discharged as recovered. 
Three and a half years after he left the hospital, I 
met his family physician who told me that this 
patient had experienced no return of insanity, and 
that he was one of the most active and reliable busi- 
ness men in the town where he lived. I heard from 
this case again, ten years later, and he was still do- 
ing well. 

Here was a case that suffered seven attacks of 
insanity in a period of nine years. His previous 
attacks had lasted from three to eighteen months 
•each. The period of recovery ranged from six to 
twelve months. He was entering upon his seventh 
attack when he received the injury, and judging from 
the past, his insanity should extend over a period of 
iirom three to eighteen months. But this blow upon 
the head apparently caused a recovery in three days, 
and this recovery continued for at least ten years, 
and, so far as I know, it has continued during the 
past twenty-two years. 

This case of recovery from insanity, by means of a 
blow upon the head, is exceedingly interesting, on 
account of both the suddenness and the permanence 
of the restoration to mental health. 

Syphilitic Mania, — This form of insanity is ac- 
quired through indulgence with those who have the 


syphilitic taint. It often springs from coarse brain 
disease induced by syphilis. 

Puerperal Mania. — Puerperal mania is simply 
acute mania associated ivith child-bearing. Its 
causes are indicated by its name. Sometimes 
insanity comes on during pregnancy and before 
childbirth. Again, it may occur within a few days 
after delivery ; and once more, an attack may come 
on several months after delivery, and during the 
exhaustion of lactation. 

This form of mania is caused by excitement or 
anxiety, or by exhaustion from over-flooding, or 
from protracted pain, or from the wastes of nursing. 
And again, the patient may become exhausted from 
the loss of sleep in caring for the child. As you may 
meet such cases in your early general practice, we 
will give you an example case of puerperal mania 
which came under my notice : 

Mrs. H. C. E., set. 27, was confined six weeks 
before being brought to the hospital. Three days 
after confinement she was attacked with puerperal 
fever which lasted about one week. When the fever 
subsided she seemed well mentally. Two days after- 
wards, and twelve days after confinement, the 
patient began to show signs of insanity. She was 
excited most of the time; was obscene, religious, 
noisy, destructive, and sleepless by spells. For a 
short time she imagined herself wealthy, but she had 
no fixed or continued delusion. The day following 
her arrival at the hospital she was very noisy and 
destructive. She repeatedly declared : "I am under 
this flag; my ship is forty-five; I came here under 
false colors.'* She mistook those around her for 
persons she had known before; when food was 

taken to her she broke the dishes ; was very violent, 


and seemed to have hallucinations of sight and 
hearing which frightened her. The patient was 
given Stramonium. After several days of excitement 
and incoherency she became more quiet and better- 
natured. Then she complained of pain in the head, 
through the temples, and over the top. Her pupils 
for sometime were considerably dilated. At first she 
cared little for food, but afterwards had an excellent 
appetite. Some weeks after admission she began to 
talk quite freely to imaginary people. She also 
heard voices, but what they said did not seem to 
disturb her, as she was good-natured and jolly. On 
account of her jolly delirium, her tendency to 
destructiveness, and particularly her inclination to 
remove all clothing, we gave Hyoscyamus, and this 
remedy seemed to have a favorable eflFect for a time. 
At length she began to menstruate, and had a 
profiise flow of bright red blood. During her men- 
struation she became more obstinate and pugilistic 
than usual. Her pupils were largely dilated. On 
account of her intense ugliness, and destructiveness, 
and the dilated pupils, and the flow of bright-red 
blood from the uterus, she received Belladonna. A 
little later the patient was not only wild, noisy and 
destructive, and inclined to remove all clothing, but 
she began to smear herself and her room with feces. 
She then had a slight period of depression, and while 
depressed she inquired for her children and her 
husband for the first time in several weeks. Then 
she began to improve, and in about three months 
after her admission she became quiet, pleasant, and 
rational. She continued to gain steadily, and in a 
little less than four months from the date of admis- 
sion she was discharged as recovered. 


This case was remarkable for the Yiolence of the 
mental manifestations, and the great physical un- 
rest. It is considered a rather unfavorable symptom 
where the patient smears herself with feces, and yet 
in spite of that the case recovered. Though noisy 
and destructive and violent day and night for 
several weeks, she was nearly all the time good- 
natured. As we have said before, we have larger 
hopes for a patient who is cheerful in spirits than 
for one who is depressed and crying, or sullen, 
morose, or obstinate. 

Hysterical Mania, — This form of mania is prob- 
ably a prolonged exaggeration of some hysterical 
condition. Hysterical lunatics think they see visions 
of the Saviour and the Saints, and receive special 
messages in that way. Hysterical insane girls think 
they give birth to mice and frogs, and they also live 
on lime, and hair, and slate pencils. Sometimes they 
indulge in hysterical convulsions, in morbid way- 
wardness, in ostentatious attempts at suicide, and 
in semivolitional retention of urine. Cases of hys- 
terical insanity should be secluded from their friends, 
and trained and disciplined and cared for until they 
become stable in mind. (Clouston). 

Disputed Forms of Mania 

The disputed forms of mania, such as mono- 
mania, moral mania, and the manias of criminal 
tendencies, might all be classed under the general 
head of subacute mania. These cases are generally 
quiet and tractable when under discipline, and they 
cherish more or less the specific delusions which are 
characteristic of that form. 

Under the influence of ideas of persecution or 


wrong, or impelled by a feeling that it is one's duty 
to rob, pillage or destroy, we have subacute maniacs 
who develop into kleptomaniacs or pyromaniacs. 
In such cases we find imbecility of the moral nature, 
together with a perversion of judgment, and an 
impairment of will power. In these cases the pro- 
cess of reasoning is at fault, the judgment is weak, 
the will erratic, and consequently the intellectual 
faculties bow before the fell influence of moral per- 
versities. We must come, I believe, to consider in- 
sanity as a unit. There is a trinity of forces in man 
which tends to sane thought, moral speech, and 
rational action — ^namely, the physical, the intel- 
lectual, and the moral forces. If the physical force 
is vigorous, if the intellectual force is keen and clear, 
if the moral force is sensitive and true as the needle 
to the pole, then you will have sane thought, sane 
action, and sane conduct. These forces are united 
as closely, and as firmly interwoven as the Trinity 
of the Universe. When one is affected, the others, 
by contact or impression, are also affected. Break 
down the physical by disease, and you have per- 
versions of both the intellectual and the moral 
forces. Hence we should dispense with the old-time 
dogma that a patient may be insane upon one 
point, and sane upon every other point. While this 
may appear to be the case, as a matter of fact if 
the man is insane upon one point, this taint of in- 
sanity affects generally his thoughts, and motives, 
and actions to a certain degree. 

Pathological States 

The pathology of mania is obscure, and as yet 
but little understood. The investigations of Edward 


Long Fox, M. D., F. R. C. P., in this direction, have 
been carefully made, and we take pleasure in quoting 
briefly from his Pathological Anatomy of the nervous 
centers. He says: ** Clinical- observation, as well as 
pathological research, leads us to consider lesions of 
the vessels as at once the primary and the most im- 
portant of all the cerebral changes in mania. It is 
this capillary distention, this hjrperemia of the 
cortical substance of the brain, that is the chief 
lesion in acute mania. This hyperemia will generally 
affect the pia mater, and, I believe, especially the pia 
mater of the convexity.'* 

Rindfleisch says that the cortical hyperemia will 
here cause a sort of stasis; this, again, leads to 
overdistension, then to atony of the vessels. This 
hyperemia of the pia mater and the cortex may be 
shown merely in a slight tinge of redness ; more fre- 
quently, however, its previous presence is manifested 
by its results. These are extravasations, diffuse 
encephalitis, affecting especially one layer of the 
cortex, and pigmentation ; and if the hyperemia has 
been long continued, or has frequently occurred, 
further changes are found to have taken place in the 
vessels themselves. 

The extravasations may take the form of puncti- 
form hemorrhages, but more usually the extravasa- 
tion has not absolutely reached the brain matter, 
but exists in the form of dissecting aneurisms of the 
small veins. Besides these minute aneurisms we find 
various dilatations of the smallest vessels, causing 
alterations of shape of variable intensity. Dr. Buck- 
nill thinks that in acute mania extravasations of 
blood are chiefly in the pia mater. 

Greding states that "the choroid plexus was 
healthy in only 16 out of 216 cases of insanity, and 


that out of 100 maniacs 96 showed a choroid plexus 
that was either thickened or full* of hydatids; by 
hydatids he doubtless meant serous cysts. The in- 
flammatory condition met with in mania is usually 
confined to the middle layer of the cortex. The ex- 
ternal layer is occasionally affected, this layer of the 
cortex coming off" in patches when the pia mater is 
removed, and bearing the appearance of ragged 
ulcerations of the external portion of the brain." A 
similar condition exists when the brain of a general 
paretic is denuded of its pia mater covering, but from 
a different cause. In paresis there are inflammatory 
adhesions of the pia mater to the cortical substance, 
and when the former is peeled off it brings with it 
small particles of the cortex, leaving a brain surface 
which appears to have upon it Ane ulcerations. In 
mania the second layer of cortical substance being 
somewhat softened, when the pia mater is removed 
there is sometimes the appearance of a rougher and 
more general breaking up of the convolutions of the 
brain than obtains in paresis. In paresis the parti- 
cles that come away are like pin points; in mania 
the cortex, if it clings at all to the pia mater, will be 
removed in patches. 



We shall to-day discuss that form of insanity 
known as Dementia. The term is derived from two 
Latin words, de, *'from," and /nens, **mind/' The 
expression, therefore, means strictly "out of mind." 
It signifies, indeed, that the human being, thus 
bereft, is, to a considerable extent, in a state of the 
most deplorable mental poverty. 

In discussing such a subject, we enter a field that 
is a vast desert waste. The paths across this field 
are strewn with the wrecks of early hopes, of joyous 
prospects, and of fruitless designs. The desert before 
us is a tiresome plain, unpeopled save by the ghostly 
images of uncertain recollection. Desolation is the 
ruling god of this desert, and destruction of men- 
tality is his desperate and continued aim. And yet, 
in every desert there are some bright spots where, 
nourished by some hidden fountain, the perennial 
verdure springs. These gardens in the midst of the 
sand are called oases, and they signify that which is 
wonderfiil, and excellent, and unexpected. In the 
desert of dementia we have discovered some bright 
and hopeful spots. We have seen the light of 
recovery flash unexpectedly across the dark and 
gloomy pathway of some apparently hopeless 
victim. There are more oases in the distance await- 
ing attention, and Science, ever progressive, bears 
aloft her brilliant torch, lighting the path to future 
discoveries, and future amelioration of disease. 


Esquirol states that dementia deprives men of the 
faculty of adequately perceiving objects, of seeing 
their relations to various things, of comparing them, 
or of preserving a complete recollection of them; 
whence results the impossibility of reasoning cor- 
rectly. Demented persons are incapable of reason- 
ing because external objects make too feeble an im- 
pression upon them, because the organs of trans- 
mission have lost a part or all of their energy, or the 
brain itself has no longer sufficient strength to re- 
ceive and retain the impression thus transmitted to 
it. Hence it necessarily results that the sensations 
are feeble, obscure and incomplete. Being unable to 
form a just and true idea of objects, these persons 
cannot compare them, or exercise abstraction or 
association of ideas. They are not capable of suf- 
ficiently strong attention; the organ of thought 
has not energy enough ; it has been deprived of that 
vigor which is necessary for the integrity of its fiinc- 
tions. Hence the most incongruous ideas succeed 
each other ; they follow without order and without 
connection. It seems as if unreal expressions were 
whispered to them by unseen tongues, and these ex- 
pressions are repeated by the patients in obedience 
to some involuntary or automatic impulse. Here we 
find examples of unconscious cerebration of a rare 
and interesting type, or rather a consciousness 
evolved from within and unrelated to association 
with external things, except through the medium of 
former impressions. 

One great point of difference between dementia 
and idiocy and imbecility is that in both the latter 
the faculties are imperfect, while in the former they 
are simply enfeebled. Idiocy is a congenital absence 
of both cerebral and mental power. It is amentia^ 


"without mind/' Imbecility means a checked or 
arrested development. A child may have fair or 
moderate mental powers until the age of six, eight, 
ten or more years. Through disease or emotional 
disaster or injury, a shock is produced upon the 
nervous system, and this shock is sufficient to check 
all future mental growth. Hence an imbecile who is 
forty years of age will have the mind and capacity 
of a child of six or ten years of age. In fact, if a 
child becomes an imbecile at ten, he will by and by 
only manifest the feeble powers of a child three or 
four years of age. That is, from the time the im- 
becility fairly begins there is a tendency toward 
degeneration. Still, there are some imbeciles who 
retain a special faculty for remembering names^ 
or for adding up figures, or for playing upon 
some musical instruments. Now dementia, meaning 
"out of mind,*' is a condition of mental failure or 
infirmity, resulting after the mental powers have 
been developed or ripened to a fair extent. Dr. 
Winslow describes dementia as "a general enfeeble- 
ment of the intellect, and in some cases an apparent 
abolition of all. mental powers.'' Mental power is 
always weakened in dementia, but comparatively 
seldom is that power utterly lost. We are speaking 
now of confirmed cases. 


Dementia may be classified in a general way as 
primary and secondary. Primary dementia is a 
disease which comes on independently of any other 
form of insanity. Secondary dementia follows in 
the wake of some other form of insanity, chiefly 
melancholia or mania; and if this condition con- 


tinues until the case is hopeless, it is then called 
terminal dementia. 

Dementia may be either acute or chronic. That 
is, it may come on suddenly and with sharp manifes- 
tations, or it may gradually develop into a hopeless 
and long continued aberration. 

Primary dementia may be sudden or gradual in 
its onset. Among the young and the poorly 
nourished, an attack of dementia is likely to be 
sudden, and then it is called acute primary dementia. 
Senile dementia (the dementia of old age) may be 
primary. That is, it may come on without any 
previous attack of any form of insanity, or it may 
come on so gradually that when actually observed 
and brought to the notice of the physician it is, to 
all intents and purposes, a chronic disease. 

To primary and secondary dementias, with either 
acute or chronic tendencies, we may add, as special 
forms of this disease, masturbatic dementia, syphi- 
litic dementia, epileptic dementia, organic dementia, 
alcoholic dementia, katatonic dementia, and senile 

Causes and Symptoms of Acute Dementia 

I now desire to call your attention to acute 
dementia, a form not common, but nevertheless 
interesting, because it afifords under proper care 
strong hopes of recovery. It is to be distinguished 
from melancholia with stupor. The diagnostic dif- 
ferences were pointed out in my lecture on melan- 

From the writings of J. Crichton Browne, as well 
as from our own observations, we learn that acute 
dementia attacks both sexes, but females in a larger 


proportion, though perhaps in a milder degree than 
males. It is essentially a disease of youth, being 
rarely seen in patients beyond thirty years of age, 
and it seems, indeed, to be often dependent upon ex- 
hausting influences operating at a period of rapid 
growth. Children whose powers are overtaxed at a 
time when the process of development is going on, 
and when nutrition has not only to repair tissue 
waste, but is also obliged to contribute to the 
formation of new morphological elements, often fall 
into a state resembling idiocy, in which they are 
dull, sullen and depressed. And the children who are 
thus affected by acute dementia are not always 
those who have displayed extreme quickness of intel- 
lect, coupled with nervous instability, who have 
been clever and fragile, or who have inherited a pre- 
disposition to insanity. On the contrary, they are 
often those who have possessed only commonplace 
abilities, who have been robust dunces, and who 
have come of a perfectly healthy stock. For it is a 
peculiarity of acute dementia that it is less fre- 
quently connected with an hereditary taint than 
perhaps any other form of mental aberration. How- 
ever diverse and multiplied the causes enumerated 
by some, we believe that neurotic tendencies have 
been assigned a prominent place among them; but 
that, perhaps, has arisen from force of habit rather 
than from accurate observation. Neurotic tendencies 
are the parents of such a multitude of evils that it 
seems one can scarcely be wrong in affiliating with 
them a malady having such a striking family re- 
semblance to their acknowledged progeny. But 
minute inquiry will hardly warrant such a proceed- 
ing; for out of many recorded cases of acute 
dementia, the histories of which were satisfactorily 


trax!ed, there were only about twenty-five per cent, 
in which an hereditary proclivity to mental or 
nervous diseases could be discovered. In most of the 
cases there was, so far as could be ascertained, an 
entire freedom from any such morbid impregnation. 

It is not, of course, asserted that this disease may 
not have its roots in ancestral mold. What is al- 
leged is that it far oftener grows out of superficial 
and individual conditions, and that they themselves 
are sufficient to account for its phenomena, without 
referring back to any hypothetical inheritance. In- 
deed, strange as it may sound, it has sometimes 
seemed that the absence of any neurotic inheritance 
was favorable to the development of acute dementia 
when its immediate causes come into play. These 
causes, such as debilitating occupations or insuffi- 
cient nourishment, when operating upon neurotic 
subjects, have appeared to lead up to other dis- 
orders, to melancholia or mania, whereas, when act- 
ing upon more stolid beings, they have induced a 
blunting of the mental powers, or acute dementia. 

It might be inferred, from what has just been 
said, that acute dementia is oftener due to physical 
than to moral causes, and that inference would be 

Moral impressions of a deleterious nature or in- 
tensity act more powerfiilly upon sensitive beings 
than upon those who are duller and steadier, and 
consequently they are not very influential over that 
class from which acute dements are drawn, unless 
physical conditions have previously produced pros- 
tration. Seldom do we hear of acute dementia being 
brought on by a fiight, or a disappointment, or a 
joyous surprise, unless a state of extreme debility 
has existed when the emotional shock happened. 


The one moral cause which is eflFectual in inducing 
this disorder is monotony of thought and feeling, or 
mental inanition. Man cannot live on bread alone. 
His dietary must be varied, and if it is not he be- 
comes starved as eflFectually as if he were on short 
allowance. The human mind demands variety as 
the necessary and imperative spice of life, otherwise 
the mental forces fall into a condition of "innocuous 
desuetude. *' Under various conditions of life, where 
new impressions and ideas are not supplied, and 
where a tedious uninteresting routine is inevitable, 
does failure of. mental power occur. This is espe- 
cially the case when the deprivation of new impres- 
sions and the imposition of new restrictions are co- 
incident with a period of mental evolution when the 
growing mind is greedy of nourishment suited to its 

Children who are sent at an early age into facto- 
ries w^here they see brick walls and hear the same 
noises from machinery day after day and year after 
year, and where their work consists of muscular 
movements requiring close attention, often pass into 
a condition of acute dementia. Young prisoners in 
jail sometimes suflFer in the direction of mental weak- 
ness from the wearisome monotony of their lives. 
Sailors stationed long at one place, where they ex- 
perience simply the rolling of the ship and the rum- 
bling of the surf, become filled with a sense of tedium, 
and frequently have attacks of acute dementia. 
Factory life, prison life, and stationary sailor life are 
inimical to mental health, and tend to produce un- 
natural weakness of the faculties. But the failure of 
l)rain force must not be charged to one cause alone. 
The majority of such cases arise, not only from mo- 
notonous existence, but also from being poorly fed 


and indifferently housed. A lowered vitality caused 
by poor food and hard work prepares the victim 
most surely for the inception and growth of thig 
grave malady. 

Acute diseases, such as typhoid and other fevers^ 
have sometimes acute dementia among their sequelae. 
It is also brought on occasionally by protracted 
diarrhea, by bleeding piles, by leucorrhea, by men- 
orrhagia, or by any severely exhausting and deplet- 
ing disease. It may even derive its origin from 
malaria or atmospheric miasma. It follows also in 
the wake of alcoholism, gluttony, and masturba^- 
tion, even as sharks follow ships that have corpses 
on board. 

But however induced, acute dementia makes its 
actual invasion in one of two ways : 

(1) It either steals over the patient by gradual 
and at first almost imperceptible encroachments for 
a few days ; or (2) it is ostentatiously ushered in by 
an attack of excitement. In the first case some slips 
of memory, some relaxations of attention, some ex- 
pression of wandering thoughts, some moments of 
blank bewilderment, are its earliest harbingers; 
while in the second case an outbreak of fury, wild 
bursts of laughter, swift meaningless movements of 
the arms and head, and the giving forth of broken 
disconnected sentences are the symptoms which an- 
nounce its presence. 

When once established in any way this disease 
manifests itself by a greater or less suspension of the 
psychical activities. Impressions are slowly trans- 
mitted to the mind, and are imperfectly assimilated, 
so that only a dim knowledge is obtained of external 
things or events by the victim of dementia. Com- 
parison is suspended, imagination has abandoned its 


creative work, desire which in health surges so 
tumultuously in the human breast now scarcely 
moves within. AflFections and passions are dormant, 
and the will is destitute of strength. This inward 
mental inability is outwardly expressed in modifica- 
tions of physiognomy, in gait, and in conduct. The 
countenance wears a perplexed and vacant expres- 
sion ; the attitude betokens lethargy or irresolution ; 
the voice loses its accustomed tone, and the limbs 
perform their duties with uncertain eflfort. The 
patient is sullen and self-absorbed. If spoken to, he 
gives no heed to what is said. His memory becomes 
impaired; his command of language is reduced to 
the minimum ; he performs his work, if at all, in a 
slovenly and careless way. Most frequently all 
labors are given up, and all exercises are renounced. 
At this stage some curious exhibitions of the imita- 
tive faculty and automatic muscular activity are 
sometimes seen. A girl acutely demented was asked 
repeatedly and forcibly : ** What is you name ?'* Be- 
ing awakened and stirred into activity, she at last 
cried out ** Elizabeth,*' and from that time for a 
whole month following, when spoken to, she 
screamed ** Elizabeth. *' In the same way, if patients 
of this class are made to walk or run, they will con- 
tinue to exercise automatically until they are 
stopped. A patient will sometimes feed herself in 
this way : A plate filled with chopped up food is put 
in the proper position, a spoon is put into the pa- 
tient's hand, and then the patient is made to dip the 
spoon into the food and convey it to her mouth. 
After doing this for a few times, she will go on auto- 
matically and empty the plate. (Browne). 

When acute dementia is of a severe type, the 
mental state becomes one of profound stupidity^ 


Comparison is abolished, memory is a blank, lan- 
guage is lost, the sentiments are lifeless, the will is 
palsied, and even the normal wants are not attended 
to. Organic existence alone remains. The sufferer is 
indifferent to all that is taking place around him. 
Pricking or pinching the skin does not cause signs of 
pain, nor does tickling produce responsive move- 
ments. The patient will sit or stand for hours in 
one position, lacking spontaneity of purpose to 
change it. Now and then a species of catalepsy is 
observed in these cases. The limbs remain for a time 
in any position in which they may be placed; the 
body in any attitude in which it may be thrown. If 
the arms are raised above the head they will be held 
there perhaps for an hour. Such an effort would 
cause intense suffering to a healthy person, and yet 
in these demented cases there is no great rigidity of 
the muscles. The limbs are flaccid, and are readily 
ffexed and extended, and it is remarkable that after 
being long held in positions in which great resist- 
ance to gravitation must be exerted, they are still 
free from stiffness. 

Of the bodily S3ntnptoms of acute dementia, those 
connected with the circulatory system are most 
prominent. They consist of feeble action of the 
heart, small and almost imperceptible pulse at the 
wrist, and passive congestion of the extremities. 
The hands and feet are cold, and have a bluish-red 
color, which disappears under pressure, leaving a 
patch of pale skin; but the color speedily returns 
when the pressure is removed. This coldness and 
blueness is very striking, and is often accompanied 
by considerable swelling. The hands and feet are 
^sometimes affected by diffuse chilblains which form 
and persist even during summer, and when the ex- 


tremities are kept Tvarm, and wrapped in cotton 
wool. There is often edema of the joints. The face 
has a puflFed and livid appearance. When excitement 
comes on in the mind of the dement, there is gen- 
erally active flushing of the face and heat of the 
head. The pupils in acute dementia are more or less 
dilated, and somewhat inactive. The respiration is 
quite shallow; sometimes the patient can scarcely 
be seen to breathe. In advanced stages of the dis- 
ease, there is liability to edema of the lungs. The 
temperature in the axilla or rectum is generally 
about normal, but in the chilled hands it has been 
known to fall as much as ten or fifteen degrees, 
Fahrenheit, below the normal standard. The tongue 
is tolerably clean; sometimes swollen and pale in 
color, and bears the imprints of the teeth at the 
edges. (Browne and others). There is almost al- 
ways a copious flow of saliva, and sometimes the 
amount secreted and poured out is very great. As 
much as a pint of saliva has been collected in five 
hours firom one case — a very fair record of sap 
exudation from a human maple tree ! The appetite 
is generally good, if pains are taken to feed the 
patient properly. Now and then the food is rejected, 
but with as little sign of nausea or emotion as a child 
manifests when it throws off its surplus of milk. 
The bowels are frequently constipated, but occasion- 
ally an exhausting diarrhea supervenes. In females 
who are attacked with acute dementia there is gen- 
erally amenorrhea, and sometimes leucorrhea; but 
the process of excretion from the membranes, except 
the mouth, seems to be checked. The female patient 
is apt to become excited at the time when the men- 
strual flux should occur. 

Upon recovering from acute dementia, the patient 


finds a great hiatus or vacancy in his memory. He 
has passed through the "valley of the shadow of 
death/' and the shades have rested like a black 
mantle upon his mind. His soul has been laved in 
the sullen waters of Lethe, and perfect oblivion of 
his sufferings is the fortunate result. In melancholia 
with stupor, you will recollect, the melancholiac is 
cognizant of every event, and remembers with clear- 
ness the details of his perilous voyage through the 
tideless, and sunless, and moonless slough of despond. 

While w^e shall in a subsequent lecture enlarge 
upon the treatment of these cases, we may tell you 
here that the prone position in bed, to favor easy 
circulation, and an abundant liquid diet, warm 
clothing, and appropriate medication, are essential 
to successful treatment. 

Chronic Dementia. — We come now to consider the 
phases of chronic dementia. 

** lyast scene of all, 
That ends this strange eventful history, 
Is second childishness and mere oblivion, 
Sans teeth, sans eyes, sans taste, sans everjrthing.'* 

The **sans everything'' to which Shakespeare 
alludes is the sad and hopeless obscuration by time 
or disease of the once bright, vigorous, scintillating 
mental powers of exuberant and lusty youth. 

Ben Johnson was once called upon to admire a 
beautifal palace, but he growled at his companion 
and urged him to hurry on, saying : " It is the sight 
of such things as these that makes death horrible." 
A contemplation of the ravages of dementia excites 
a horror of existence, for it reveals a life full of grand 
possibilities shorn at the last of every vestige of 
mental cheer ; and it proves w^ith crucial force that 


Kving with such deprivations in prospect is a most 
solemn and trying thing. It is a solemn thing to die, 
but, as Mrs. Partington says, "it is a good deal 
solemner to liTC.'' But when we are brought face to 
face with the unfortunate physical wrecks of 
humanity, we are compelled by duty not to shrink, 
but to examine carefully the sources of the wreck, 
and to patch it up, and make it more comfortable 
and habitable for its spiritual occupant, if possible. 

After the disappearance of a severe attack of 
acute mania, the effects of the shock are sometimes 
visible in a certain condition of mental weakness 
without actual intellectual disorder. The force of 
character seems to have been snapped, and the finer 
moral and esthetic feelings, which are the bloom of 
culture, are abolished. The physiognomy has lost 
its highest expression, and the individual presents 
the appearance of a certain childishness. This is one 
end of the scale of degeneration, but at the other the 
mental powers are almost obliterated, the acquisi- 
tions of the past being completely blotted out. 
There is no interest in the present, and the patient 
leads a merely vegetative life. Between these two ex- 
tremes of slow weakness on the one hand, and 
absolute mental failure on the other, we note every 
shade of transition from strength to helplessness. 

The countenance of the chronic dement no longer 
expresses any fixed passion. There is a want of 
harmony, or, as it were, a dislocation of the feat- 
ures, and the most that is manifested is the shivered 
expression of a passion, or the shattered wreck of a 
smile. There is a corresponding imbecility on the 
motor side. Some can continue their former occupa- 
tion, or can do a little simple manual work; but 
there is no sharp energy impelling to action. Not 


infrequently the industrious breadwinner of a large 
family concludes, in a condition of dementia, his 
busy industry on earth, by gathering bits of stone, 
or pieces of glass, or wood, or any small, light, mov- 
able objects that come in his way. Strange propen- 
sities of all kinds are exhibited, as, for example, to 
sit on the floor doubled up like a jack-knife, to stand 
or crouch in a particular comer, to walk backward 
and forward for a certain distance on a particular 
strip of ground, to fantastically ornament the per- 
son with feathers or flowers, or to repeat some par- 
ticular phrase. A patient will get hold of a delusion 
and repeat it automatically for days, and weeks, 
and years. Hallucinations and illusions of the ex- 
tremest kind are frequent, and tend to sustain the 
delusion. One woman nurses as her child a lump of 
wood decked in rags ; another person, whose singu- 
lar movements seem unaccountable, is busy spinning 
threads out of sunbeams, while a third continues the 
most violent movements of his arm in order to pre- 
vent the motion of the universe, or of his own blood 
from coming to a stand. The mood may be of surly 
depression or of more or less exaltation. 

The bodily health is usually good, the patient fre- 
quently getting stout as the active symptoms of 
mania or melancholia subside into the calm of 
dementia. Some patients suffering with chronic 
dementia may be made to work, but they require 
most careftil guidance. 

The end of chronic dementia is usually death. 
Occasionally a recovery takes place during the onset 
of some acute disease. One case of four years' stand- 
ing, and apparently hopelessly demented, recovered 
his mental powers during a severe attack of tonsil- 
litis. During this attack his temperature ran up to 


105°F, and lie became delirious and talked in a ram- 
bling and muttering manner. The inflammatory 
conditions were remarkably intense. When they sub- 
sided, the mind was clear, and the patient talked 
quietly and rationally. He continued to improve for 
several months, and finally recovered and returned 
to his home, and resumed his work as a blacksmith. 

This man's memory of events which occurred dur- 
ing his dementia was completely obliterated. He 
experienced four years of mental obfiiscation. After 
recovery, his memory of facts and events, which had 
been presented to his mind before his illness, was as 
clear and strong as ever. 

We have dwelt at some length upon acute and 
chronic dementia. We will now consider, briefly, 
some of the special forms of dementia due to par- 
ticular or specific causes. 

Masturbatic Dementia. — This form of insanity is 
a result of that perversive and brain-impairing vice 
familiarly known as *^ self-abuse.'' Sometimes a 
person addicted to this unfortunate habit will suffer 
with remorse to the extent of developing mild or 
acute melancholia. And again, the victim of mastur- 
bation may pass into a condition resembling sub- 
acute mania, where the patient is sullen, irritable, 
suspicious, and often thinks himself the victim of 
some conspiracy or plot to injure him. But all cases 
of masturbatic insanity eventually terminate in 
dementia, unless cured or relieved of this deplorable 

In patients suffering with masturbatic dementia, 
we find, as a rule, but very moderate intellectual 
powers, and especially are the forces of the will weak 
and erratic in their operations. The animal pro- 
pensities are strong and unrestrained. These persons 


are frequently of a religious cast of mind. Indeed, 
one of our patients thus afflicted was in the habit of 
saying his prayers, and of masturbating at the same 
time. It may seem almost sacrilegious to refer to 
such a fact, but it is proper that you, as physicians, 
should be put upon your guard, and when you sus- 
pect a given case of masturbating, you should not 
be diverted from your investigations by the assur- 
ances of the parents that the boy "is very good, and 
says his prayers regularly.*' 

The treatment of masturbatic insanity must be 
moral, medical, dietetic, and hygienic. The proper 
course to pursue is to carefully examine the sexual 
organs, for the purpose of discovering abnormalities, 
and if such exist an operation should be performed. 
The boy should be circumcised, while, if necessary, 
the hood should be removed from the clitoris of the 
girl. Then by keeping the parts clean, the source of 
irritation may be dispensed with, and the disposi- 
tion to masturbate may be cured. 

These patients should be taught the folly of their 
actions, and at the same time they should be made 
to feel that such an unwise use of God-given powers 
does not constitute the unpardonable sin, nor pre- 
clude the possibility of recovery and usefulness. 
They should be encouraged by their family physician 
to leave off bad habits, and likewise to abstain from 
too much remorse. 

Those addicted to unfortunate personal habits 
are generally seclusive, and inclined to hide away 
from everybody, especially from those of the oppo- 
site sex. The lives and the habits of such patients 
should be changed. They should be lifted from their 
settled grooves of thought and action. They should 
be taken from their books, their prayers, and their 


solitude, and placed among genial and active people 
of both sexes. These patients often profess a great 
love for books. They retire to their rooms or to 
some secluded forest shade ostensibly for study, but 
in reality to indulge in lecherous imaginings, le\7d 
thoughts, salacious efforts, and peccant practices. 
They should not be allowed to dream or dawdle 
themselves into dementia, but they should be stirred 
in other directions, and elevated to better and nobler 
things. Their energies should be restrained, and 
stored up for future drafts established by the wise 
and glorious economy of nature. Farming, herding 
cattle on horseback, engaging in railroad enterprises, 
mining, or any work that is hard and reasonably ex- 
hausting to the physical forces, are the proper chan- 
nels of toil for such cases. Out-door air, both in 
sunshine and in storm, is a necessity ; and plenty of 
plain food, and a hard bed to sleep on at night, and 
constant association with those who are clear- 
headed and watchful, are likewise demanded. 

Syphilitic Dementia, — ^This form of dementia some- 
times supervenes among those who have led fast and 
disreputable lives. These cases are generally hope- 
less, although death and other unfavorable symp- 
toms may be postponed or mitigated by appropriate 
medication. Syphilitic dements usually have gummy 
deposits or tumors in the brain. These may produce, 
besides loss of memory or loss of sight, paralysis of. 
one or both sides of the body, and finally a series of 
convulsions in which the patient dies. It is said that 
almost every case of epileptiform seizure occurring 
after the age of forty is due to a neurosis dependent 
upon syphilis. Traumatic injury may, of course, 
produce some cases of epilepsy after middle life. 

Epileptic Dementia, — Epileptic dementia frequently 


foUo^Bvs a long continued series of epileptic fits. Vic- 
tims of epilepsy are quite apt to be depressed or 
melancholy at times, or again maniacal in their 
speech and action. But at last they nearly all be- 
come more or less demented. Such cases require 
close care, good nursing, light diet, and such sympa- 
thy as their helpless and deplorable state demands. 

Organic Dementia. — Organic dementia is an en- 
feeblement of the mental powers, complicated Avith 
or supervening upon a paralysis of one or both sides 
of the body. It is usually a disease of middle or 
advanced life. It follows frequently an attack of 
apoplexy, or it may occur after long continued glut- 
tony or drunkenness. It may arise from syphilitic or 
other tumors of the brain. It may owe its origin to 
excessive sexual indulgence, or to excessive care, anx- 
iety or overwork. Even an uncontrolled fit of anger 
might induce it. Organic dementia is the result of a 
marked and positive brain lesion. Therefore but 
little hope of a permanent recovery may be indulged 
in. However, as the lesion is commonly local, it 
may, with good care, be partially relieved. Nature 
is always on hand after every local injury to the 
system with a powerful "work gang,'* and the task 
of repair and clearing up the debris is sometimes 
happily and unexpectedly accomplished. Even if the 
channels of thought and action are clogged, new^ 
channels may be opened. Collateral circulation may 
take up and perform successfiiUy the work of nourish- 
ment, even where a main artery has been plugged by 
an obstructing embolus. Hence we should be un- 
remitting in our efforts to relieve cases of organic 
dementia, for some cases may be materially helped^ 
although the vast majority can never recover. 

Alcoholic Dementia. — This form of dementia is 


produced by the protracted use of alcoholic stimu- 
lants. In this form the failure of mental power is 
not so marked as in some other forms ; but the de- 
plorable feature in these cases is that the disease is 
self-induced, is largely avoidable, and, worst of all, it 
strikes down some of the strongest and best men the 
world has ever known. 

Remedies for the relief of alcoholic dementia are of 
little avail so long as the exciting cause continues; 
yet a too sudden withdrawal of long continued ac- 
customed stimuli might result, in some instances, in 
a still deeper dementia. Therefore, the physician in 
treating such patients needs profoundest wisdom 
and ripest judgment if he would do what is really 
best for his case. Probably the wisest thing you 
can do for the welfare of the community is to warn 
the young against excesses of all kinds. The last 
and bitterest result of overindulgence in strong 
drink, or in any other excess, is an engulftnent in the 
yawning pitfall of dementia. 

Katatonic Dementia. — Patients affected with this 
form of dementia repeat constantly and deliberately 
the same sentence or phrase. For instance. No. 1659 
says: "I think my name is E. E. W. My own dear 
mother, who was kind and faithful to me for many 
years, that was my own precious mother from my 
birth for many years, that took faithful care of me 
for many years, called me sometimes Libbie, and I 
think my name is Elizabeth. My own dear father, 
who was kind and faithful to me for many years, 
sometimes called me Libbie. I think I do not promise 
to stay in this room. I don't think it necessary for 
me to marry any man. A woman told me I must 
not marry any man." 

Senile Dementia. — Senile dementia is the result of 


both old age and of acquired cerebral disease. It 
should be carefully distinguished from simple old age 
or dotage. In the latter case the mind is weakened, 
but the patient is clearly conscious of his own w^eak- 
ness. He forgets a name or a date, and gropes 
about in his memory to find it. The dement is not 
conscious of loss of memory, but applies wrong 
names to persons, and serenely thinks he is right. 
Senile dementia is something more than the mere 
loss of mental power which results from the natural 
decay of the faculties. It is complicated also with 
those pathological changes which are essential to the 
production of insanity. It does not consist alone in 
the enfeeblement of the faculties, because if it did we 
would find that every old man is a victim of senile 
dementia. There are several stages or degrees of it. 
In the first occurs a loss of memory, particularly of 
recent events, without any serious impairment of the 
reasoning faculties. Early impressions and ideas 
long retained now come up fresh from their rest- 
ing place. From forgetfiilness of recent events, 
accompanied by recollections of early ones, occur 
many of those gaps in ideas and incoherence that, in 
part, constitute dementia. This defect, or loss of 
memory, generally marks the commencement of de- 
mentia from this cause, but not invariably. Some- 
times it begins with nervous erethism, accompa- 
nied by the excitement of some faculty, fimction, or 
active power, which may act with great energy. 
Some become irritated by the slightest circumstance ; 
others experience venereal desires long since extin- 
guished; while others still, of regular, temperate and 
sober habits, all at once manifest an appetite for 
highly seasoned dishes and intoxicating drinks. 


These symptoms are soon succeeded by those of 
absolute dementia. 

The second degree is characterized by a loss of the 
reasoning power. Either the reflective faculties are 
so completely impaired that they are unable to exer- 
cise their functions, or the other faculties are so com- 
pletely prolapsed that normal functions are no 
longer exercised. The emotional faculties are so 
much enfeebled that the will does not possess suffi- 
cient strength and energy to carry out any process 
of reasoning. The premises are scarcely laid down 
before they are forgotten. Hence the inability to 
draw conclusions from them. The transaction of 
any business which requires a sustained attention 
becomes impossible. Any slight or irrelevant idea in 
disturbing the attention draws the mind away from 
what it was considering, and thus destroys all at- 
tempts at continuous effort. Some individuals in 
this stage recognize their friends, but seldom mani- 
fest any signs of emotion on seeing them. 

The next stage, or third degree, is termed ** incom- 
prehension," and is attended by an inability to com- 
prehend the meaning of any principle or proposi- 
tion, however simple, that is proposed. Attention, 
memory, reason, all but the mere instincts, are 
entirely lost. Here is sometimes found a great degree 
of physical activity, such as jumping, running, or 
walking. Some talk unmeaning jargon; others 
mutter half sentences or broken expressions; while 
others are found sitting in silence, scarcely pronounc- 
ing a syllable for weeks, months, or even years. 

The fourth and last degree consists in a loss of in- 
stinctive action. The mode of existence is merely 
organic. There is neither desire nor aversion, hardly 
a consciousness of life. 


One more point concerning dementia. You may 
be called upon in the courts to give evidence as to 
the testamentary capacity of a person suflfering with 
dementia. To do this justly, you must be able to 
distinguish between dotage (old age) and dementia. 
In both cases there is weakness of the mental powers, 
but the victim of old age is, as I have already said, 
cognizant of that fact. The senile dement does not 
realize his condition, and more than this, if any 
mental power is left he cherishes delusions or false 
beliefs on account of the imperfect or erroneous im- 
pressions received by his disordered senses. A clear 
statement of facts as you discover them by a 
cautious examination, and by a careful diagnosis 
between the mental weakness of age and the mental 
obliquity of brain disease, may enable you to con- 
serve the ends of justice. 

Pathological States 

The blood vessels of the bodies of acute dements^ 
and especially the capillaries and veins, are dilated, 
and their walls relaxed. The circulation throughout 
is languid and sluggish. The general condition of 
the mind is that of relaxation and obftiscation. 

The pathological state of the brain of chronic de- 
ments maybe best described by the term ** cerebral 
chilblains." There is atony and dilatation of the 
veins of the pia mater; the arachnoid becomes thick- 
ened and opaque ; while the dura mater is but little 
changed. The general condition is too sluggish to 
produce any marked pathological impression upon 
the dura mater, which is a tough membrane. The 
frontal and parietal lobes are water-logged upon the 
surface, and wasted within. The gray matter is 
paler than usual, and the brain substance is tumid. 


spongy, and edematous. The stasis or clogging oi 
the circulatory apparatus of the brain readily ac- 
counts for the marked mental failure. 

The pathological conditions induced by the exces- 
sive use of alcohol are thickening of the membranes, 
slow serous effusions, atrophy of the cerebral sub- 
stance, with sclerosis or hardening of the tissue. 



We invite your attention to-day to the last gen- 
eral form or division of insanity — ^namely, General 
Paresis. This formidable and fatal disease is a cos- 
mopolitan type of all modem insanity, and repre- 
sents to the fullest degree the eflfects of toil, worry, 
and intemperance in every shade and form. It is a 
deep-seated, far-reaching, intractable scourge which 
fastens its fangs upon the matured brains of its vic- 
tim, and it rarely, if ever, yields up its hold. 

Early in the nineteenth century Esquirol made 
note of the fact that a person suffering with insanity 
complicated with paralysis was not likely to recover. 
In 1822, Bayle made some successful observations of 
the disease, and outlined its description. In 1826, 
Calmeil, a French physician, first intelligently and 
carefiiUy described the disease known as general 
paresis. Not until 1843 did Dr. Luther B. Bell, of 
the McLean Asylum, near Boston, discover it in this 
country. He reported several cases of the disease, 
all of which died. In 1847, Dr. Pliny Earle, at that 
time of the Bloomingdale Asylum, gave to the pro- 
fession a few more cases of the disease ; and about 
the same time Dr. Brigham, of the State Hospital at 
Utica, detected and described the so-called new 

Much has been written upon this same subject 
since its first discovery. Probably the fullest and 
most notable work upon General Paralysis of the In- 


sane is by William Julius Mickle, M. D., M. R. C. P., 

But while modern doctors have studied the dis- 
ease very fully, and while they have w^ritten much 
upon this subject, no one has more concisely de- 
scribed the disorder and its inevitable termination 
than Shakespeare. Nearly three centuries ago, this 
great polychrest of thinkers and observers wrote, 
concerning the then undiscovered paretic : 

* * Things small as nothing, for request's sake only, 
He makes important: possessed he is with greatness; 
And speaks not to himself, but with a pride 
That quarrels at self -breath: imagined worth 
Holds in his blood such swoU'n and hot discourse. 
That, 'twixt his mental and his active parts, 
Kingdom 'd Achilles in commotion rages. 
And batters 'gainst itself. What should I say ? 
He is so plaguy proud, that the death-tokens of it 
Cry — No recovery. ^^ 

Troilus and Cressida, Act 11^ Sc, 3 

The synonyms of general paresis are: General 
paralysis, general progressive paralysis, general pa- 
ralysis of the insane, mania de grandeur^ and de- 
mentia paralytica or paralytic dementia. The latter 
term might more appropriately be applied either to 
the last stage of this general disease, or to a condi- 
tion of both mental and physical loss following apo- 
plexy, embolism, or thrombosis. 

Just here we wish to define the difference which we 
conceive to exist between paresis and paralysis. The 
latter term implies a loss of the powers of motion, 
either complete or partial. Accompanying this loss, 
there is frequently an impairment of sensation as 
well. Paralysis is from the Greek, TrapXvw, ** I loosen.*' 
Paresis is from the Greek, TrapirjfUy **I relax,'* and 
means a relaxation of the nerves of motion. In its 


eflfects upon these nerves it diflfers in degree from pa- 
ralysis. Through the influence of paresis the nerves 
become less "taut" than natural, and the result is a 
certain tremuldusness of the muscles controlling the 
organs of speech, and a general inaccuracy in the 
movements of the arms and legs. The nerves re- 
spond to every impulse for action, but in a lax and 
hesitating manner, just as the strings of a violin give 
forth imperfect sounds when they are but partially 
tightened. In paralysis there is no response to im- 
pulses of the will in the afilected parts. Some one or 
all of the strings in the human violin are completely 
unstrung or broken. 


General paresis may be divided into four stages, 
namely : 

1. The incipient or irritable stage; the stage of 
worry, anxiety, sleeplessness, and melancholy. 

2. The well-defined stage of the disease ; the stage 
of maniacal excitement, and of active delusions of 
wealth, of power, and of grandeur, alternating in 
some cases with attacks of temporary depression. 

3. The stage of subsidence, w^hen the patient 
passes into a condition of subacute or chronic 
mania, with a general but slow tendency toward de- 

4. The stage of terminal dementia, of physical as 
well as mental failure, and of death. 

The first stage is usually marked by a long con- 
tinued and suspicious prodrome. The man who has 
been active and hopeful in appearance, yet withal 
concealing an undercurrent of worry and anxiety, 
becomes at last unable, through the effects of subtle 


disease, to carry on concealment any longer. The 
disease has robbed him of his natural carefulness. 

The prospective victim of paresis worries more 
than is his usual custom. Gradually his sleep is 
shortened, and disturbed by anxious dreams. The 
tendency to sleeplessness and anxiety may be accom- 
panied by a sense of heaviness and fullness in the 
brain, and this frequently extends to the degree of 
positive pain, although some paretics assert that 
they never had a headache. Still, the brain changes 
which are observed after death would indicate that 
the pains of slow, subacute inflammation have been 

From sleeplessness, melancholy, anxiety, and wor- 
riment, the patient passes through the heaviness of 
mental abstraction, until he suddenly loses self-con- 
trol, and indulges in outbursts of anger. The de- 
pressed and irritable stage is passed usually in a few 
w^eeks or months, although this condition may last 
two or three years before the upheaval of maniacal 
excitement. In some cases the physical symptoms of 
paresis are present, and the patient passes from a 
condition of melancholy to a state of dementia with- 
out being called upon to endure the excitement oc- 
casioned by the cherishing of delusions of w^ealth and 

Even in the melancholic stage it will be observed 
that the paretic is more earnestly engaged in project- 
ing enterprises than heretofore. In doing so he loses 
his ordinary prudence in the affairs of life. He also 
forgets the principle of right and wrong, and some- 
times becomes a thief, because he thinks everything 
he can lay hands on is his own property. The blunt- 
ing of the perceptions of justice, and truth, and right, 



and honor is one of the first evidences of approach- 
ing paresis. 

Having passed through the stage of worry, anx- 
iety, depression, and loss of the moral sense, the 
patient finally develops full-grown delusions of 
wealth, and power, and grandeur. At this stage 
the natural affections of the man seem to fail. The 
normal common sense having departed, the paretic 
indulges in wild and extravagant purchases, or in 
unwarrantable business schemes. He begins to feel 
"first-rate," and yet he is evidently failing; and also 
he becomes tremulous in body, and unsteady in 
mental action. 

The physician who is called to see an active 
paretic in the early maniacal stage will probably 
discover some of the following indications : 

1. The pupils are either unequally dilated (one be- 
ing larger than usual, while the other may be con- 
tracted), or the pupils may be equally dilated, or 
equally contracted. But in either case they are irre- 
sponsive to light, that is, the motor muscles of the 
pupil do not respond quickly and naturally to the 
stimulus of light. Irresponsiveness to light," on the 
part of the pupils, is characteristic of nearly every 
case of general paresis. 

2. The patient is unable to control the motions 
of the eye. There is a certain restlessness and un- 
steadiness in moving the eye which, to a careful ob- 
server, is often discernible. Of course, people sujBFering 
with chorea, or paralysis agitans, or some other 
nerve disorder, may suffer with eye twitchings ; but 
the history of their cases will eliminate them from a 
consideration of paresis. 

3. A dropping of one comer of the mouth is some- 


times seen, owing to a partial paralysis of the facial 

4. There is a marked tremulonsness of the lips and 
tongue. This tremulonsness of the paretic should be 
diagnosed from that of acute drunkenness, or mental 

5. A slight hesitancy of speech is apparent, as well 
as a deliberate attempt to overcome this inability to 
articulate clearly. 

6. There is a tendency to stammering, especially 
when using words in which the letters i, /, xn, r, and 
e occur. 

7. There is a slight unsteadiness of gait, that is, 
the patient has a shambling uncertain step as if the 
knees were tired, and the owner could not determine 
which way to bend them. 

8. There is a smoothing out or a partial oblitera- 
tion of the natural lines of intelligence in the face. 

9. The skin presents a sallow and wax-like ap- 
pearance, and sometimes feels as if it were greasy. 
Greasiness and fiabbiness are characteristic of the 
skin conditions of the paretic. 

10. A slight exaltation of temperature. The tem- 
perature of a paretic often runs from one-half to two 
degrees above the normal, and during a convulsive 
seizure, to which he becomes liable, the temperature 
may go much higher. 

These are some of the physical signs of paresis 
in the active stage. Mentally, there is an intense 
disturbance of the imagination. Visions of bound- 
less wealth are conjured up in the overwrought 
mind of the patient. A sense of power, the most 
magnificent, pervades his every thought. He him- 
self is the greatest and strongest man and finan- 
cier in the world. (Women paretics have delusions 


about gold and diamonds, rich clothing, numerous 
children, fine houses, and grand carriages. Women 
paretics do not often attempt to make money. They 
simply endeavor to spend what has already been 
made). The expansive delusions are contrary to the 
natural belief of the patient. Generally the victims 
of paresis are plain, hard-working, common sense in- 
dividuals, although they may be mercurial and ardent 
in temperament, and ambitious to get on in the 

Under the influence of his mighty projects, the 
paretic loses the power of considering the common 
affairs of life. He forgets familiar names. He fails 
to remember recent dates of appointments. He also 
loses the power of calculating. His delusions multi- 
ply and reduplicate fortunes in geometrical order, 
while the forces of the mind, as applied to common 
things, diminish in arithmetical ratio. Some paretics 
make little account of immense fortunes, but they 
fancy themselves the possessors of numberless wives, 
or they see themselves pursued by countless enemies, 
or they think themselves able to drink innumerable 
flagons of wine. But whether the current of thought 
is toward strong drink, or seductive sirens, or Crce- 
sus-like wealth, it is a current that is forever widen- 
ing and deepening until its unfortunate burden is cast 
into eternity. 

Sometimes, at irregular intervals, between his fit- 
ful visions of unearthly grandeur, the paretic patient 
sinks into the gloomy abyss of melancholy. There 
are days when he weeps easily, and sends up a wail 
of anxiety and hopelessness which contrasts with his 
customary lofty and exuberant spirits as the moum- 
fttl strains of the Dead March in Saul contrast with 


the sublimer sweeps and surges of the Hallelujah 

As the active paretic indulges in delusions of 
strength and wealth, so he is likely to use the ordi- 
nary courses of business transactions with which to 
develop not only his special projects, but also to re- 
veal his mental condition. The paretic patient will 
often write scores of letters or telegrams in a single 
day. He is always in an intolerable hurry to accom- 
plish his w^ork; therefore he seeks to use the tele- 
graph and the fast mail for the purpose of accom- 
phshing his ends. It is an interesting fact that the 
more excitable an insane person becomes, the larger 
and more irregular are the letters which he makes. 
In addition to making the letters large, the patient 
in writing often omits words, or letters from words. 
This may occur from inattention, and from the hurry 
to get through the task. Occasionally the patient will 
adorn his rhetoric by gaudy illustrations with col- 
ored pencils. When the excitement subsides, and the 
patient becomes quiet and calm, he will often resume, 
to a certain extent, his natural style of writing; that 
is, the letters will be formed upon a more moderate 
plan, but the words or parts of words may still be 
omitted. The paretic uses so much force and ink in 
the construction of his letters, and is so anxious to 
finish them, that they are often marred and blotted. 

From the state of active delusion and active exer- 
tion, the patient passes slowly and surely into what 
may be termed the chronic state of paresis, w^hich is 
marked by an exaggeration of all physical weak- 
nesses, and a subsidence of the delusions, with occa- 
sional flashes of excitement or attacks of depression. 
The unsteadiness of gait becomes more pronounced ; 
the tremtdousness of lips and tongue is strikingly 


apparent ; the patient is careless of dress and person, 
and in every way we note a decadence of physical 
and mental powers. Sometimes the appetite in this 
stage is enormous, and the patient takes on loads of 
fat. This soon passes away, and leaves the patient 
thinner than ever. The march of the disease may be 
interrupted by an episode of epileptiform convul- 
sions, at which time partial paralysis may occur. 
These attacks are often brief, the paralysis lasting 
only a few hours or days. 

After an attack of these convulsions, the patient 
loses ground rapidly. The mind fails, and dementia 
supervenes. The appetite is capricious, the physical 
strength wanes, the body emaciates, and the nerves 
atrophy. The skin, which has been flabby, sticky, 
and clammy, is now apt to break out in eruptions 
known as pemphigus foliaceus. At first these large 
watery blebs are noticed on the extremities; after- 
ward there is superficial ulceration of the derma, 
followed by scabbing and attempts at healing. 
These sores heal slowly, if at all. It is one of the 
most remarkable features of this strange disease 
that the patient may continue to live long after all 
the forces of life appear to be exhausted, and when 
little remains but the skeleton, overlaid by a parch- 
ment-like and very ragged skin. Of course we are 
now describing an extreme case, though many of this 
kind have come under our observation and care dur- 
ing the past twenty-five years. Relief from life comes 
at last through utter exhaustion. Sometimes for 
several hours previous to dissolution, the patient 
becomes unconscious and thus passes away. With 
others, consciousness remains until very near the 
end, and with the last articulate breath of conscious 
life the dying man, corrugating his countenance into 


a ghastly smile, will reply to your inquiries as to 
how he feels to-day with the stock expression, **fuss 

The pulse of paretics is soft and weak. This is 
due to the relaxation of the muscular coats of the 
arteries, and probably relaxation of the heart itself. 
Every portion of the paretic's body is, to a greater 
or less extent, relaxed and unable to perform normal 
duty. The stomach and bowels partake of the gen- 
eral relaxation, and the food is often passed undi- 
gested. Lack of assimilation of food accounts for 
the gradually increasing weakness and exhaustion 
which this disease produces. 

There is sometimes danger to paretic patients in 
the act of eating, for they cram their mouths so full 
of food at times as to almost suffocate. The muscles 
of deglutition, also, being relaxed and eccentric or un- 
certain in action, will sometimes suddenly fail, and a 
patient will choke to death by the impaction of food 
in the larynx. When a patient is inclined to eat 
voraciously and rapidly, he should be fed carefiiUy 
by an attendant, and his food should be of a liquid 
or semi-liquid nature. 

The paretic patient will sometimes grind his teeth 
by the hour or by the day, and this is thought to be 
a diagnostic symptom by some. But cases of acute 
delirious mania will often grind their teeth, and so 
will some cases of chronic dementia. 

That you may see how naturally the actual facts 
in given cases coincide with the pen picture which we 
have presented, we will now give a few condensed 
extracts from the records of the hospital under my 
charge. The histories which we shall reveal will 
bring you face to face with grim and sad realities. 

P. B., act. 50, married. Symptoms of mental de- 


rangement had been well marked for nine months 
previous to admission. For many years Mr. B. had 
been engaged in business requiring a severe mental 
strain. He was a man of excellent and methodical 
habits, and strictly temperate, save in matters of 
overwork and worry. Previously to the attack of 
paresis his health had been good. In temperament, 
he was of the nervous order. In disposition, he was 
hasty and impulsive, although kind, and from prin- 
ciple, carefully self-controlled. Three years before ad- 
mission to the hospital, however, it was noticed that 
he became unusually overbearing in his manner, and 
for one year prior to admission was subject to noc- 
turnal excitement. During the previous summer he 
was attacked with melancholy, which was followed 
by a maniacal outburst. 

When admitted, Mr. B. was in good bodily health, 
although he was not sleeping well. The only thing 
he complained of was a necessity for passing his 
water somewhat too frequently. He was very rest- 
less, and spent his time walking up and down the 
hall, talking to himself, and taking no notice of any 
one. He claimed that his wife had been unfaithful to 
him; and he also entertained the delusion that the 
attic of the hospital building was stored with chests 
of gold belonging to him. He worried and talked so 
much about this, that he was finally taken to the 
attic and allowed to examine it, and was greatly 
disappointed at not finding any trace of the treasure. 
Ordinarily he complained of no pain, and considered 
himself perfectly well. For sometime this patient 
continued his active exercise during the day, and 
slept but little at night. After a time, when appear- 
ing quite well, he admitted that his only brain 
trouble was **forgetfiilness.'* Most of the time, how- 


ever, he cherished and manifested delusions concern- 
ing persons and events. At one time he indulged in 
great railroad schemes, and was going to build an ele- 
vated twelve-track road between all the large cities in 
this country. This road was to be placed upon tres tie 
work two hundred feet in height. Again, he had the 
delusion, which he disclosed every day for several 
weeks, that there were nine hundred, or more, head- 
less bodies in the basement of the building in which 
he was located. Again, he expressed very seriously 
a wish to exchange heads with some one. And 
again, he projected the idea of starting an immense 
printing office w^hich would contain five hundred 
mammoth Hoe presses, with which he would do all 
the printing in New York City. While engaged in 
these mighty projects, with the idea constantly in 
mind that he could accomplish each one of these 
chimerical enterprises, his memory was rapidly fail- 
ing. He became so weak in this respect that he could 
not remember even the names of his constant attend- 
ants. He would ask the same questions over and 
over many times in the course of a few minutes. At 
length he came to have hallucinations of hearing, 
and would frequently talk to imaginary persons. 
Physically, he varied; at times eating ravenously, 
and taking on much flabby flesh ; at other times fail- 
ing in appetite, and correspondingly losing in weight. 
It was noticed that he went often to urinate, and 
that he drank large quantities of water. He was 
watched on account of these peculiarities, and it was 
observed that during ten hours he urinated eleven 
times, and drank copious draughts from the water 
tank seventeen times, besides drinking much at 
meals. It was estimated that he sometimes drank 
between three and four gallons of water in a single 


day. At such times he would consume with his food 
large quantities of salt, pepper, and vinegar. His 
friends, failing to secure from us any favorable prog- 
nosis, determined to try a change of treatment. He 
was taken to a water cure for a few days, and then 
transferred to the care of a distinguished old school 
physician in Connecticut who declared, so we were 
told by the friends, "that the case was not by any 
means incurable." He continued, however, to run 
down, and died about a year and a half later. 

In this case you will observe that the cause was 
neither intemperance nor sexual excess, but simply 
mental strain from business cares and worry. Also 
there may possibly have been some hereditary taint, 
which we believe to be unusual in such cases. The 
father and mother, brothers and sisters, were always 
mentally sound, but a maternal aunt was reported as 
insane. The delusions in this case were marked, and 
sleeplessness was a symptom, though many paretics 
sleep well. The patient drank large quantities of 
water without having any marked fever, a symptom 
w^hich we have observed in quite a number of cases. 
In no other non-febrile disease is there likely to be 
such ravenous thirst as in paresis. 

J. A., aet. 41, married, but had no children. The 
disease had been gradually making its appearance 
for about six months. The assigned cause was in- 
temperance or fast living. Our prognosis was un- 
favorable from the outset. The friends gave as the 
history of the case that the patient had been ** irri- 
table and strange-acting" for about six months; 
that he had been a hard drinker for a long time, and 
very ardent in the performance of marital duties. 
During the two weeks previous to admission he had 
been reckless, violent and unmanageable. This ex- 


citement continued, and in fact increased after his ad- 
mission. He indulged in many violent acts while 
under the influence of delusions. Physically, he was 
running down rapidly, so that it became necessary 
to restrict his tendency to overexercise. At this 
time he claimed that he was "king of gods ;" that he 
made all the people of the earth, and that he could 
raise all who had been dead over fifty years. He 
claimed that he owned the whole world; that his 
clothes were covered with diamonds. He wrote and 
sent off* continually telegraphic messages to imagin- 
ary persons. He declared that Queen Victoria, the 
Empress Elizabeth, and the ** queen of poets" be- 
longed to him as wives, and that he made them. The 
patient was very forgetful of common and ordinary 
names. During the second night of his stay with us 
the patient thought that he made a trip to Heaven, 
and gave to one of his friends there one hundred bil- 
lions of dollars. In the morning he wanted two 
hundred and fifty millions of gold with which to line 
his room. He afterward thought that this wish had 
been complied with, He slept very little for several 
nights, but after a time greatly improved in this re- 
spect. Physically, the patient was very weak and 
scarcely able to walk, though he imagined that his 
strength was limitless. His pulse for sometime 
ranged from 64 to 100. When the pulse was low he 
seemed much prostrated and enfeebled ; when it was 
high he became w^ild and incoherent. The pupils 
varied, the left being generally more dilated than the 
right. When the left was normal, the right would 
become contracted. The patient's speech was thick 
and his words could scarcely be distinguished, yet his 
delusions were utterly marvelous. At times he would 
create several worlds in a single night. Again, he 


would be the possessor of numerous wives and 

About one month after admission the patient's 
ideas of wealth passed away. He said that they 
were only visions, and that he again felt poor. For 
about two months he gained gradually, both in 
mind and body. He gave up his delusions and talked 
rationally, and the only apparent abnormal symp- 
tom was a slight tremulousness of lips and tongue 
when speaking. The patient was discharged at the 
request of his friends. Although, to the untrained 
observer, he appeared quite well, the result of his 
case was entered upon our books as ** improved," 
and his relatives, when pressing us for an opinion as 
to his future, were assured that he would, in all prob- 
ability, suffer a relapse within six months, and that 
he would never fiiUy recover. The sequel proved 
that our prognosis was correct, for about five 
months from the date of his discharge the patient 
was readmitted. It was stated that he had been 
quiet most of the time during his absence from the 
hospital, and had attended meetings and gatherings 
for amusement, but had worked at his business 
scarcely at all. His friends said that he had gener- 
ally appeared well, but not always "exactly right." 
The night before he was returned he became violent^ 
and attempted to kill his wife with a hatchet. He 
had delusions that enemies were after him, and that 
he must fight them. He had no apparent ideas of 
grandeur, and had cherished none during his vaca- 
tion. A month later the patient had several slight 
temporary attacks of left-sided paralysis, after which 
he gradually failed in memory until he did not know 
his own room. Then he became very wealthy again^ 
and thought that he owned the hospital, and was 


planning to stock it ^th millions of dollars worth 
of goods. He claimed that he had seventy immense 
and costly stores filled with innumerable goods in 
New York City. While cherishing these delusions he 
seemed for a time to improve physically. After a 
while blisters and sores appeared upon his hands, 
and then he became less excited and more moderate 
in his ideas. The ulcers on his hands finally healed, 
and the patient appeared better mentally, having 
given up his delusions of wealth. Under ophthalmo- 
scopic examination, atrophy of both discs was re- 
vealed. A month later he suffered another attack of 
temporary paralysis of the left side, and his delusions 
of wealth revived. He began to steal all the books 
he could find, and locked them up in his bureau. He 
was also caught masturbating, although he had 
heretofore manifested no tendency in that direction. 
He continued in this condition for about two 
months, and then gave up his delusions of wealth, 
and was again depressed. His appetite failed, and he 
subsisted mainly upon milk and beef tea. Finally, 
the sphincters became relaxed, and he frequently -wet 
the bed. Two months later he had epileptiform 
seizures, but rallied from them. He was greatly 
emaciated, weighing only eighty-two pounds, and 
yet for a time he appeared once more to be gaining. 
His appetite improved, and his spirits were remark- 
ably exuberant for an almost dead man. The week 
following he had another epileptiform seizure ; it was 
one of general and severe convulsion. The next day 
he rallied and could talk, and still he manifested 
delusions of wealth. He gradually lost in flesh until 
he weighed but seventy-three and a half pounds. His 
urine was retained, and it was drawn with a 
catheter. The patient was unable to swallow, and 


-was fed regularly with a soft rubber nasal tube. A 
month later the patient passed into a comatose con- 
dition from which he rallied, recognized those about 
him, spoke pleasantly, and assured us that he felt 
" fuss-rate.'* A few hours later he quietly died. 

A post mortem examination was made, and the 
scalp was found to be very thin, as was also the 
skull. On removing the skull-cap, three ounces of 
serum escaped from the subdural space. The sub- 
arachnoid spaces were likewise found to be filled 
with serum. The arachnoid membrane was decid- 
edly opaque. The pia mater was adherent to the 
cortical substance of the brain, the result of long 
continued inflammation. The brain weighed forty- 
three and three-fourths ounces. 

This case presents the most salient points of pa- 
resis. The age, forty-one, the very prime of life ; the 
condition, married, but having no children, conse- 
quently no bar or interruption to sexual excess ; the 
apparent cause, intemperance, and the final result, 
death after such marked improvement as to insure 
the patient's discharge for several months from the 
hospital ; and through a period of nearly two years 
the persistent abnormality of articulation, and the 
condition of the pupils, together with the rise and 
fall of delusions of grandeur and wealth, all these 
form an imposing array of important and interest- 
ing facts. 

Mrs. F. E. E., aet. 31. The causes of insanity were 
put down as ** grief and physical debility.'' At the 
time of admission this patient was weak and un- 
steady on her feet. There was slight tremor of the 
tongue, and on extending the arms and hands, the 
fingers trembled and twitched constantly. She had 
a "happy-go-lucky" disposition at times, and again 


was depressed. She rambled from one subject to 
another, and took but little interest in her surround- 
ings. Her temperature fluctuated between 99° and 
101° F. She had a good appetite, slept well, and ap- 
peared perfectly contented, always answering that 
she felt "first rate" when questioned as to her feel- 
ings. Two months from the date of admission the 
husband removed the patient to her home, but was 
obliged to return her to the institution seven months 
later. She was then debilitated, filthy, demented, 
and inclined to be violent when annoyed. She pre- 
sented no symptoms of delusions or hallucinations. 
On using her arms and legs, she exhibited consider- 
able unsteadiness and loss of power. The tongue 
was very tremulous, and she experienced much 
trouble in pronouncing certain words. The intellect 
gradually became weaker and weaker; she omitted 
words when speaking, and often repeated others 
several times. She crammed her mouth in an imbe- 
cile manner when eating, and had to be watched 
carefully, to prevent choking. The patient gradually 
became more helpless and demented, dazed and 
feeble. There was sordes on the teeth, the tongue 
was red, and pointed to the left side. The skin 
bruised easily, and was cold and dry, flaking off 
easily. Later the patient was unable to swallow 
solid food. The body became covered with red 
spots, and the temperature rose to 102.2° F. The 
eruption disappeared quickly, and the temperature 
fell to normal. At this time the patient was in a 
condition of absolute dementia, with muscular 
atrophy throughout the entire body ; and legs, arms 
and hands were contracted. About two weeks later 
she passed away. 


Here was a case demented almost from the very 
first, and at no time presenting any delusions of 
grandeur, wealth or position ; and although the pa- 
tient was practically bedridden from the inception of 
the disease, she lived over four years. 


We come now to consider some of the causes of 
general paresis. 

A nervo-sanguine temperament, great physical ac- 
tivity, vaulting ambition, imperfect education (many 
men go into fields of great enterprises with very lim- 
ited education, and with only half-trained brains), a 
desire to attain and enjoy all good things in life, 
coupled with anxiety and worry — that is, fear lest 
the object in view may not be gained, or if gained, 
may be unsatisfactory — these are the substrata of 
conditions upon which the superstructure of general 
paresis almost always rests. 

The paretic is an adventurer, an explorer, a dis- 
coverer of new means for the acquirement of wealth, 
a diviner with a magic wand of imagination that 
conjures up golden Golcondas in every business 
scheme. Some of the most brilliant toilers and work- 
ers for the growth of this new land have finally suc- 
cumbed to paresis. Some of the brainiest of actors, 
and wittiest of writers, and most zealous of poli- 
ticians, and skilfiil managers of great railroad sys- 
tems, have yielded to this dire disease ; and the cause 
lies in a hyperstimulation of the brain and nervous 
system by such means as hard work, coupled with 
hard drinking, excessive sexual indulgence, and an all- 
absorbing worry about every undertaking, whether 
it be in the world of business or in the field of 


Clouston says that "the things that most excite 
and at the same time most exhaust the highest brain 
energy are those which tend most strongly to cause 
the disease ; to wit, over and promiscuous sexual in- 
dulgence combined with hard muscular labor, a stim- 
ulating diet of highly-fed flesh meat, the being all the 
while excited and poisoned by alcohol and syphilis ; 
all these things begun early in life and kept up stead- 
ily." He declares that in Scotland **the Durham 
miner when earning good wages fulfils the most per- 
fect conditions for the production of general paraly- 
sis. Every sixth lunatic admitted to the Durham 
County Asylum is a general paralytic.'* Clouston 
also states that ** the Asiatic is not subject to paresis, 
that the savage is free from it, and that the Irishman 
and Scotch Highlander must go to the big towns or 
to America to have the distinction of being able to 
acquire it." There are comparatively few cases of 
general paresis where the causes may not be traced 
to overwork in the field of worry, wine and women. 
Some European authors have claimed that every 
case of paresis is tainted with syphilis. While it is 
true that paretics are likely to be exposed to syphi- 
litic infection, it is not, we believe, either the universal 
cause or the invariable accompaniment of paresis. 
We can hardly accept the dictum of the Austrian pro- 
fessor of syphilitic diseases. After listening to a lec- 
ture in Vienna, I asked the professor if he had noticed 
the affect of syphilis in the production of insanity. 
He replied that he had not considered the matter, and 
could not give the desired information, but closed his 
remarks smilingly by saying: ** You know. Doctor, 
that the whole civilized world is sypbilized P^ We 
will admit that a considerable portion of the victims 

of paresis have the syphilitic taint, but there are some 


paretic patients whose sexual habits have been cor- 
rect so far as could be ascertained, and who have suf- 
fered only with worry and anxiety about business 
affairs. Such cases have overtaxed their physical and 
mental powers, and produced inflammatory condi- 
tions of the brain ; but they have neither tarried too 
long at the wine cup, nor indulged in promiscuous 

Imperfect education, a bounding ambition, and a 
feeling that one's strength will never give out may 
rank as predispositions to paresis. A young man 
with hopefal disposition, and strong, full-blooded 
physique, will work and play with such a lack of 
judgment as to land him at last in the bottomless 
pit of paresis. Full of hope and health, he does not 
realize the fact that there is a possibility of breaking 
dow^n when he works like a slave all day, and enjoys 
festivities like a Satyr and an Epicure all night. 

In considering the causation of paresis, we note 
the influence of sex, and find that at the Middletown 
State Homeopathic Hospital there have been thus 
far under treatment two hundred and fifty male 
paretics and thirty-one female paretics. Possibly 
men work harder and worry more than women, and 
they may be less elastic than those of the opposite 
sex in meeting and braving the ordinary vicissitudes 
of life. 

Paretics are more numerous in cities and in sea- 
port towns than in the country. It is also a notable 
fact that most paretics are very fond of rich meats, 
and of strong coffee. A vegetarian mode of living 
would probably save many from this disease. 

Paresis develops usually between the ages of 
twenty-five and fifty years. Dr. Clouston tells of a 
case which developed at the age of sixteen, and Dr. 


Guislain reports one at the age of seventeen. Occa- 
sionally this disease may develop in old age, but the 
insanity of that period of life usually takes on the 
form of senile dementia, with its many-colored va- 
garies, instead of paresis. 


The inflammations of paresis seem to involve in a 
general way those portions of the cerebral mem- 
branes which cover the frontal and parietal lobes. 
Dr. Clouston has stated that when the mental symp- 
toms are most severe the inflammatory processes 
will be found located on the anterior and upper con- 
volutions of the brain. If convulsive tendencies are 
present, then these inflammatory patches will be 
found at the base of the brain, and in the region of 
the fourth ventricle. Also, Broca's convolution is 
much involved when the speech has been especially 
affected. The meninges in paresis are usually in- 
flamed and thickened, and the pia mater, — that is, 
the inner membrane — ^is adherent in small pin point 
spots to the brain cortex. Under the influence of in- 
flammation and the thickening of the membranes, 
the brain mass itself becomes compressed, and we 
have a condition, of atrophy of the nerve cells during 
the latter stage of the disease. It has seemed to me, 
also, that there has occurred in many cases an hyper- 
trophic metamorphosis of the neuroglia. In other 
words, the mass of cellular connective tissue which 
keeps in place the nerve cells and the nerve fibres in 
the cerebrum has become thickened. When this oc- 
curs, there is pressure not only from above down- 
ward, but from below upward, and from within 
outw^ard, thus placing the nerve cells and the nerve 
wires of communication from the brain to the va- 


rious parts of the body between what maybe termed 
upper and nether pathological millstones. Some- 
times the disease appears to start in the spinal cord 
and work upward to the brain, and sometimes the 
disease begins at the top of the brain and works 
down into the cord. 

The pia mater when peeled from the paretic brain 
takes with it small, fine portions of the cerebral sub- 
stance. The arachnoid membrane sometimes be- 
comes opaque, and has small flaky deposits, together 
with serous effusions. The dura mater is commonly 
thickened and gorged with blood, and it presents a 
loose, leathery, roughened appearance, which is a 
strange contrast to the fine, smooth, closely woven 
condition of the membrane in health. Occasionally 
tumors of a gummatous nature are found in the 
brain of paretics. Atrophy and sclerosis of the cere- 
bral mass, and likewise of the great nerve tracks of 
the body, are conditions generally found. The lungs 
of the paretic are usually sound, but there is shallow 
respiration. The heart becomes weak and uncertain 
in its action; the kidneys are somewhat degenerated, 
and symptoms of Bright's disease now and then 
present themselves. 

Diagnosis, Prognosis and Treatment 

Paresis may be confounded with locomotor 
ataxia, progressive muscular atrophy, and senile 
dementia. While the muscular movements may 
simulate those of ataxia and atrophy, you will 
remember that mental aberration does not usually 
accompany locomotor ataxia or muscular atrophy. 
Senile dementia may be distinguished quite com- 
monly from paresis by the age of the patient, and by 
the absence of those very exalted delusions which 


paresis engenders. From alcoholic dementia it may 
be distinguished by the history of the case, and by 
careful observation. The alcoholic dement is more 
vague and uncertain and less persistent in his delu- 
sions than the paretic. Of course if a drunkard and 
a paretic are locked up in a hospital and kept under 
observation for a sufficient length of time, the drunk- 
ard will get well, while the paretic will continue on 
his pathological toboggan slide to the end. 

The prognosis is unfavorable, and usually the pa- 
tient dies within from one to eight or ten years after 
the inception of the disease. By means of rest in bed, 
and a suitable diet, and proper care, the paretic may 
live for several years. Whether the patient is in bed, 
or up and dressed, he should be afforded an abund- 
ance of fresh air and balmy sunshine. These blessings 
should be brought to him ; he should not be obliged 
to run after them. He should also be protected from 
severe draughts of cold air, as the skin is apt to be 
flabby and moist, with a sticky perspiration, and 
consequently he may easily take cold. On the other 
hand, he should be protected from the rays of a hot 
sun, because excessive heat is extremely prostrating 
and injurious to the average paretic patient. 

Paretic patients should be secluded from every 
care and toil. During remissions they may exercise 
very gently, but they should be kept in bed when 
they have reached the weak and tottering stage. 
They should not be allowed to associate with other 
excited patients, or run any risk of getting bruised or 
tumbled about. 

The beds for paretic patients should be soft, 
elastic, and comfortable in every particular, to avoid, 
so far as possible, the danger of bed-sores. The 
patient's skin should be kept clean and firm by the 


use of alcohol baths, applied with a sponge, about 
once in forty-eight hours; and wherever pressure 
occurs the skin should be oiled once or twice a day 
with cocoanut oil, gently but carefully rubbed in. 
By a judicious use of oil, and alcohol and water, and 
by the use of proper beds, and by skilful nursing, 
the paretic patient will avoid, as far as possible, the 
distressing annoyance of that hete noire of the hospi- 
tal — namely, the bed-sore. If, in spite of every pre- 
caution, a bed-sore should occur, then it may be 
cleansed with Calendula tincture diluted with water, 
three parts of the former to one hundred parts of the 
latter. The ulcer may then be packed with Bichloride 
of Mercury, one to five thousand. Should the pro- 
cess of suppuration make deep inroads, then Peroxide 
of Hydrogen will cleanse and help to heal all the by- 
ways where pus is inclined to form and pocket. Vas- 
eline with Calendula or Carbolic Acid maybe applied 
as an emollient dressing, after the ulcer has been 
thoroughly cleansed. A smooth bed and scrupulous 
cleanliness are the main essentials in the treatment 
of a bed-sore. 

If you are called upon to select a climate for a 
paretic, you should recommend Florida or Southern 
California during the winter, and a slow, easy march 
to the North when hot weather comes on. But if the 
patient is unable to travel, then a moderate and uni- 
form climate should be selected if possible. If you 
cannot regulate the climate, then you should regu- 
late the temperature of the room in which the pa- 
tient is kept, and if you can maintain it at from 68 
to 70 degrees Fahrenheit, you wiU do what is best 
for your patient. 



The question now arises : What shall be done to 
save men and women from the inception and inva- 
sion of this fell scourge ? For fifty years the task of 
curing general paresis has been attempted by faithful 
and learned men, yet with only negative or unsuc- 
cessfiil results. While we may record with pride a 
series of triumphs against the ordinary foes of life, 
we stand aghast before the inroads of this unyield- 
ing vampire. Such being the fact, would it not be 
wise to apply the means for prevention, rather than 
engage in the discouraging task of patching up or 
seeking to save the shattered fragments of an inevi- 
table wreck ? The causes of paresis have been pointed 
out. Prominent among these figure worriments, and 
intemperance of various kinds. To prevent the 
growth and development of these subtle causes 
among the young, the vigorous and the successful, 
we must give to them a better education, a loftier 
purpose to shun evil and to do right, a clearer knowl- 
edge of what that right is, and a most invincible de- 
termination to accomplish the greatest good in life 
without shattering one's forces upon the rocks oi 
dangerous and needless excess. When the people, 
through advice and warning from their physicians, 
are brought to know and to realize the fatality of 
their own self-imposed diseases, they may then, per- 
haps, be induced to refrain from those formidable dis- 
sipations whose feet take hold on destruction, whose 
bite is like that of an adder, and whose final resting 
place is a hopeless chamber and a death-bed within 
the walls of a hospital for the insane. 

The cares and afflictions of ordinary life, the re- 
verses of fortune, the depletions of disease, the hered- 


itary weaknesses which come down to us from our 
ancestors, all bring to institutions for the insane 
their quota of sufiFering victims ; but many who are 
thus afflicted may be stimulated by the hope of 
restoration, and may indeed get well and return in 
due time to their homes, and to a life of usefulness. 
But for him who progresses to paresis through the 
by and devious ways of his own worriments, and 
dissipations, and gorgings, and exhaustions, there 
are no more cheering words than those engraved 
upon the portals of Dante's Inferno : 

** Who enters here, leaves hope behind." 

Young gentlemen: We have led you over a long 
and tedious pathway. The march has been dry and 
dusty, yet you have borne the heat and burden of the 
day with a patient fortitude. I trust that you have 
come to realize the importance of learning something 
about insanity. It is imperative that you, as pro- 
gressive physicians, should know something of in- 
sanity, because it is prevalent everywhere, among 
all classes and grades of people — the mighty and the 
lowly, the poor and the rich. Again, you should 
know something about its modem treatment. It is 
a difficult disease to treat and to cure, and yet some 
recoveries are attained by a practical application of 
the Hospital Idea. 

As we study and investigate this question aright, 
we are forced to the conclusion that insanity is an 
almost universal disease. It has, indeed, been a 
most dreaded scourge throughout the ages. As we 
examine the pages of history, we find that this terri- 
ble disorder has stalked through the high places of 
the palaces of the old Roman Csesars. It has swept 
down like a Black Death upon the thrones of Spain, 


of France, of Austria, and of Italy. It has buried its 
cruel fangs in the brains of Bavarian and Belgian 
monarchs. It has moved upon Russia with a force 
greater than that which accompanied Napoleon 
when he marched through snow and ice upon the 
burning city of Moscow. It has sat at meat with 
the mightiest rulers of Great Britain, converting 
them into maniacs and dements, whose presence 
upon the throne has formed the darkest blot upon 
the pages of English history. And it has traversed 
the mountains of the North, and infested that fair 
and favored land which was once blest with the 
rulership of a Gustavus Adolphus, and inspired by 
the songs of a Jenny Lind. 

Prince, peasant, and pauper alike have felt the 
blighting touch of this withering witch who has 
spread her death- wand over the civilized world for 
many centuries, and whose ravishing activity is to- 
day sapping the vitality and dissipating the mental 
energy of the strongest nations on earth. 

It is our duty to disclose the nature and the dan- 
gers of insanity, and it is your duty to learn some- 
thing about it, in order that you may be able to 
assist in its prevention, and in its appropriate treat- 
ment. No one-sided philosophy will explain its 
nature, and no routine practice dispel her enchant- 
ment. Only the earnest student who studies this 
aberration of mind without fear and without prej- 
udice will learn the secret of its enchantment, and so 
dissolve the spell. 

Who shall cure this dread disease ? Only the pa- 
tient psychologist, the enthusiastic student, the 
philosophical physician, and the earnest and zealous 
philanthropist. The task is a mighty one, and in its 
accomplishment one needs the courage of the soldier, 


the zeal of the preacher, and the heroism of him who 
would rescue from midnight flames the helpless vic- 
tim of a conflagration. He who engages in this 
work of leading the insane back to health, and who 
spares no measure of brain or blood in the act, is a 
person who is deserving of that glorious epitaph of 
Lamartine's: "Workman in the cause of humanity." 



We now approach the last, yet most important 
division of our subject, — namely, the Treatment of 
the Insane. 

When you are called to see a case of insanity, you 
may be required to decide upon the disposition of the 
case. That is, you may have to determine as to 
whether the patient shall remain at home, or go to 
a private sanitarium, or be committed to a State 
hospital for the insane. 

In all ages, the disease known as insanity has been 
regarded as a disgrace, more or less, hence it has 
been concealed from general observation both by the 
patient and his friends. This concealment of mental 
weakness or aberration is natural, because the 
human being is so constructed that he almost al- 
ways endeavors to hide his defects of both body and 
mind. Therefore, when you are called to treat a case 
of insanity, you should not hastily consign the vic- 
tim to a public hospital, for by so doing you may 
put a public stamp upon the entire subsequent life of 
your patient. That a person has been insane should 
not be regarded a disgrace, but simply a misfortune ; 
yet the fact remains that when once his insanity is 
known, the person is always afterward likely to be 
regarded with suspicion and distrust by those 
around him. That feeling will by and by, in the 
coming enlightenment of the world, pass away, but 


until it does we must consider its efFect in the dispo- 
sition of each case brought to our attention. 

Home Treatment. — Some insane patients may be 
cared for at home, although, as a general rule, the 
disagreements with home life, experienced by the in- 
sane man, are a bar to recovery. Home treatment 
may, however, be attempted for the following class 
of cases : 

1. Those w^ho are w^ealthy, and who can afford 
the luxury of every possible care. Such patients may 
be put in charge of trained nurses and experienced 
physicians, if the friends are willing to convert a por- 
tion of the house into a hospital, and are willing 
to refrain from interfering with the necessary care 
and treatment. If the attending physician cannot 
control and direct the treatment absolutely at home, 
then he should suggest a change. 

2. Quiet and harmless insane patients— that is, 
cases of chronic melancholia where the delusions 
have crystallized, and where the disposition to sui- 
cide has subsided. Also, there are cases of chronic 
dementia, or of imbecility, or of senile dementia, that 
may be cared for in private homes or in cottages, if a 
reasonable amount of patience and tact and watch- 
fulness can be exercised in their behalf In treating 
the insane, you should always consider, first, the 
feasibility of home treatment. 

Sanitariums. — ^When the interests of the patient, 
or the highest interests of the friends demand that 
the insane person should be removed from home, 
then the next question to decide is : Where shall he 
go ? If he is blest with the luxury of wealth, he may 
be sent to a sanitarium, if a suitable one can be dis- 
covered. Great care should be used in the selection 
of a sanitarium. The welfare of the patient will 


depend upon the nature and character of the man 
in charge of such a place. If the spirit of avarice 
holds sway, then it is likely that the patient will get 
but small return for a large outlay. Private sani- 
tariums should be careftdly inspected by public offi- 
cials in such a way as to promote the interests of the 
patients, and in such a manner as to accomplish fair 
and just results between man and man. Sanitariums 
have their advantages. By going to such a place the 
insane man is enabled, oftentimes, to hide his disease, 
and consequently his fancied disgrace, from his neigh- 
bors. If he can go to a sanitarium and get well, he 
returns to his home and the community where he 
formerly lived, and immediately takes his old place 
in good and regular standing. He has simply been 
absent from home, to recuperate from nervous pros- 

State Hospitals, — When the resources of the home 
and of the sanitarium have failed, or when the finan- 
cial ability of the patient can no longer meet the 
strain of either home or sanitarium care, then a 
public hospital that is free to the poor, and moderate 
in its charges to those who have a little money left, 
may be secured. To this end, the State hospitals 
have been established. 

When a patient is sent to a State hospital the 
method should be straightforward and honest. If 
able to comprehend anything, he should be frankly 
told that he is sufiering from mental disturbance, 
and that his friends propose taking him to an insti- 
tution for treatment. He may object, but his scruples 
may often be overcome by kindly reasoning. If that 
is of no avail, then force, rather than deception, 
should be resorted to. Everything pertaining to his 



removal should be conducted in a prompt and 
orderly manner after a preconceived plan. 


The means which we have employed at Middle- 
town for treating the insane may be put down as 
follows : 

1. Kindness and gentle discipline. 

2. Rest as a means for physical and mental recu- 

3. Bathing and massage. 

4. Enforced protection. 

5. Artificial feeding. 

6. Dietetics. 

7. Exercise, amusement and occupation. 

8. Moral hygiene. 

9. Medicine. 

Kindness and Gentle Discipline. — Formerly in- 
sanity was considered as a visitation from the Devil, 
a possession in every fibre by his Satanic Majesty, 
and the treatment consisted of punishment — such 
punishment as confinement in a dark cell for the 
comfort of the soul, chains for the aching limbs, 
stripes for the back, shower baths for the heated 
blood, and for the drooping heart there were con- 
jured up the inspiring influences of gaunt and ghastly 
fear! But, to-day, the treatment of the insane is 
based upon the broad and comprehensive principle 
which is embodied and shadowed forth in the pre- 
cepts of the Golden Rule. Kindness is the Blarney 
Stone which every man, who would attempt the 
work of treating disordered intellects, must kiss, and 
thus imbibe its inspiration. To be sure, the insane 
must be controlled and governed, but while the ad- 
ministration of discipline is at times necessarily firm 


and unjrielding, it should in every word and action 
be tinctured with the essence of human benevolence. 
The more irresponsible the patient, the gentler and 
more sympathetic should be the treatment. As pa- 
tients resume their normal condition, they may be 
more and more subjected to the influence of laws nec- 
essary for proper government. As loss of self-control 
is a prominent indication of insanity, so a resump- 
tion of self-restraint is a pleasant indication of ap- 
proaching recovery. 

Rest in Bed. — When a patient is admitted to the 
hospital, he is at once carefully examined by one of 
the medical officers of the institution, and if he seems 
debilitated, eveii though manifesting much excite- 
ment and insane strength, he is sent to one of the 
hospital wards and placed in bed, where he may be 
under the constant care of trained and skilled nurses. 
For many years we have made constant repose in 
comfortable beds a prime adjuvant in the treat- 
ment and cure of insanity, and in prolonging the 
lives and promoting the comfort of those who are 
aged and feeble and unlikely to recover. We find 
that the victims of every form of insanity, whether 
that form be characterized by mental depression, or 
mental exaltation, or mental enfeeblement, or mental 
failure, are greatly benefited by bed treatment. The 
victims of melancholia rise more surely from the 
** slough of despond" when placed in bed, and prop- 
erly nourished and protected from every adverse 
exposure, than when they are allowed to sit up and 
be dressed. The victims of mania become quiet and 
tractable, and make better progress toward recovery 
in bed than anywhere else. The victims of general 
paresis are less liable to receive injuries, and their 
paroxysms of tremulous excitement subside sooner 


when plaxred in bed than when they are dressed and 
staggering about the ward. The victims of dementia 
are less filthy, and can be better cared for and made 
more comfortable in every way when in bed than 
when up and dressed, and planted in chairs along 
the corridors of hospital wards. Apathetic and de- 
pressed patients are not only less filthy when sub- 
jected to careful hospital treatment in bed than when 
up and around the ward, but they also sleep more 
during the twenty-four hours than they otherwise 
would. They likewise take their food better, and 
thus physically thrive more prosperously than when 
out of bed. We have observed many cases where 
patients on being taken from the bed and dressed 
would refuse to eat their food, but when returned to 
a recumbent position upon an easy mattress they 
would immediately begin to take their customary 

The advantages of this plan are : 

1. The waning forces of the patients are most 
surely conserved. 

2. An easy circulation of the blood throughout 
the entire system is facilitated, and thus the wastes 
produced by disease are most speedily and naturally 

3. Digestion and assimilation of suitable food, in 
cases where the normal functions of the body are 
much below par, are best promoted in bed, providing 
suitable care and treatment are administered. 

4. The patients are more readily protected from 
injuries when in bed than when dressed and allowed 
to wander about the ward in association with dis- 
turbed or violent patients. 

5. The application of heat is most readily made, 
and its benefits most uniformly secured when the 




patients are in bed and careftilly covered with suit- 
able clothing. The danger of exposing the extremi- 
ties to chilling draughts is thus most surely averted. 

6. Attendants treat bed patients with more tender 
consideration than they usually bestow upon cases 
that are dressed and about the ward. A sick person 
when in bed always excites more kindly sympathy 
and more attentive care than when he is attired in 
his usual clothing, and moving about among his 

7. An insane person if weak in body, and either 
excited or depressed or apathetic in mind, recovers 
more rapidly and certainly when afforded proper 
bed treatment than when allowed the freedom of 
daily exercise. I believe that many of the insane 
may be saved from the trackless realms of chronic 
dementia if suitable rest treatment is afforded and 
enforced during the stormy, or sullen, or obfiiscated 
experiences of mania, or melancholia, or acute 

Rest in bed does not mean neglect by nurses. On 
the contrary, it means increased care by specially 
trained nurses. The patient must be carefully and 
regularly looked after; his skin must be kept in 
good condition; his mouth must be cleansed with 
pure water at regular intervals ; the bowels, if con- 
stipated, must be relieved by enemas of warm water; 
the bladder must be emptied of its contents as often 
as that organ becomes filled ; and baths of various 
kinds must be given. 

We use baths as follows : 

1. The simple towel or sponge bath, where the pa- 
tient's body is laved a little at a time with alcohol 
and water — one part of alcohol to four or five parts 

of water, — and then the part is rubbedjuntil dry. 

. I 


2. The spray bath is used for those who are strong 
enough to sit up. This bath not only cleanses the 
skin, but stimulates by its fine and exhilarating force 
the subcutaneous nerves throughout the system. 

3. The old-fashioned tub bath is given to those 
who desire it, using warm water at the outset, and 
finishing with cold water and a brisk rubbing. 

Bed patients also receive massage when neces- 
sary ; and they are sometimes anointed, from head 
to foot, every night with cocoanut oil, or olive oil. 
We use. externally, when the patient seems very 
much strained and exhausted, cocoanut oil, ninety- 
five parts, and Hypericum tincture, five parts. Hy- 
pericum is called, as you know, the "Arnica of the 
nerves,** and this preparation is a most soothing and 
agreeable one. If the patient has, upon admission, 
recent bruises upon the body, we apply Arnica and 
oil in the same way. Old bruises which are dark 
from subcutaneous hemorrhages may be treated 
with Hamamelis and oil. 

Enforced Protection. — Many of the weak and ex- 
hausted patients coming to us for treatment are 
quite willing to rest in bed. They are already the 
victims of overwork, and rest comes to them as a 
boon which has been desired for years, but which 
could not heretofore be attained. Others require to 
be restrained to a certain extent. This restraint, or 
care, or protection may be applied by a nurse who 
will put the patient back to bed whenever he gets up, 
and kindly encourage him to remain there ; or, if that 
is insufficient, we use a body bandage. That is, a 
band is placed around the waist and fastened at the 
back with soft tapes. On either side of the body band- 
age is a strip of cloth that is tied around the bed rail. 
The restless, incoherent, and harmless patient is kept 


quiet by this means, for he finds, after a Uttle, that 
he cannot get up, and therefore stops trying to do so» 
' Others are restless all over ; constantly moving the 
legs, the arms, the body, and the head. In such cases 
we apply what is known as the *' protection sheet,'' 
which is an addition to the body bandage, and 
which covers the entire body, with the exception of 
the head and neck. When this protection sheet is 
carefully applied, the patient cannot get out of bed, 
nor can he hurt himself in any way. If his knees are 
chafed from motion, then he should wear drawers, 
or a bandage may be applied, extending from the 
ankle to the middle of the thigh. An ordinary surgi- 
cal bandage applied as if to hold a splint in place 
will answer the purpose. 

Some patients are pugilistic, and inclined to hurt 
others ; or they are suicidal, and inclined to mutilate 
themselves. We protect such cases by the use of 
padded mittens. Large canvas mittens are made 
and padded with cotton, and inside the cotton we 
place a smaller mitten to hold the hand. When these 
mittens are properly used, the patient can do but 
little damage to either himself or others. (The * ^pro- 
tection sheef was first applied at the Middletown 
State Hospital over eighteen years ago, and it has 
been used here, as needed, ever since. It has also 
been introduced into many of the progressive insti- 
tutions of this country). 

In your private practice, you may be called upon 
suddenly to take care of a very violent and restless 
case, and if you have no appliances at hand, you 
may make a cocoon by taking three or four common 
sheets, such as you will find in every house. Sew 
these together, and roll them up like an ordinary 
bandage, and then apply the bandage to the entire 


body, from the head down, just as you would band- 
age an arm or a leg. You may pinion the arms to 
the sides of the body, before applying the cocoon, 
with long towels or strips of cloth. When a patient 
is rolled up in this cocoon, and the end of the roll is 
fastened with safety pins, you may put him in bed, 
and he cannot get out, or move around at all. The 
cocoon is simple and effective. If you are obliged 
to apply the cocoon rather snugly, as in the case of a 
fiercely excited patient, it is wise to put a few layers 
of cotton over the chest, to relieve the inflexibility of 
the bandage. 

Exercise, Amusement and Occupation, — After the 
newly admitted patients have been favored with 
rest treatment for a sufficient length of time (and 
that time may be one month, or three months, or six 
months, or twelve months), then we prescribe exer- 
cise, amusement, and occupation for them. At first 
they are allowed to sit up in an easy chair; then 
they are allowed to walk around the day-rooms; 
then they are permitted to play on the piano, or play 
cards, or dominoes, or billiards. A little later they 
are allowed to exercise on the grounds. The exercise 
is increased until the patients are suflficiently hard- 
ened to engage in some useful occupation, such as 
working on the wards, or in the dining-rooms, or in 
the sewing-rooms, or folding clothes in the laundry, 
or cultivating flowers in the greenhouse, or promot- 
ing the growth of vegetables and grains in the gar- 
den and on the farm. By such a course of treatment 
we have had the pleasure of seeing apparently hope- 
less cases, after long periods of rest and nourishment, 
rise from sick beds and progress to genuine and sub- 
stantial recoveries. After rest and care and nourish- 
ment have effected both physical and mental recup- 


eration, then the duties and burdens of life may be 
gradually reassumed. But labor should be imposed 
in very moderate doses, and the drug of toil should 
be given in the attenuated form. 

In the care and treatment of the insane great 
caution should be exercised while the almost recov- 
ered are completing the term of convalescence. As 
the twilight and the dawn are the most dangerous 
seasons for those of suicidal tendencies, so the last 
days of convalescence, when the patient is feeling 
once more the impulses of recovery, are oftentimes 
critical periods which need special attention. 

ArtiBcial Feeding, — Insanity is a symptom not 
only of mental aberration, but likewise of physical 
depletion and cerebral exhaustion. Especially is this 
true with regard to the various forms, shades and 
degrees of melancholia and mania. We find in those 
suffering with mental depression, oftentimes a direct 
lack of desire for food, while those laboring under a 
stress of mental exaltation are quite apt to neglect 
the inception of nourishment through inattention 
rather than through anorexia. 

The first essential in the dietetic treatment of the 
unwilling insane for curative purposes is the en- 
forced administration of sufficient quantities of food, 
to prevent too rapid waste throughout the indi- 
vidual system, and to promote recuperation from 
losses already sustained ; and likewise to increase, if 
possible, the capitalized resources of the human form 

The second essential is the selection of such food 
as will most rapidly and surely promote the rebuild- 
ing of those portions of the human temple which 
have been disgruntled or shattered by the effects of 


The third essential is the administration of the 
selected food in such a manner as to avoid all un- 
necessary shocks ; to promote, in fact, easy and rapid 
digestion, and to favor the speedy assimilation of 
digested food by the tissues of the body. In our ex- 
perience we have found that forced feeding may most 
readily be applied by the use of a soft rubber naso- 
stomach tube. This tube, as now used, was the in- 
vention of one of my former assistants, Dr. N. 
Emmons Paine, and is a modification, both in con- 
struction and use, of the soft rubber catheter of 
Nflaton. When this tube has been inserted through 
the nose, and passed on to the stomach, by a phy- 
sician or skilled nurse, the food may be injected 
through it in required quantities by means of an 
ordinary rubber syringe. 

Those who continue the administration of food | 

through the old-fashioned stomach tube prefer, as a 
rule, I believe, that the patient shall be in a sitting 
posture when fed; but when using Dr. Paine's soft 
rubber naso-stomach tube it seems preferable to 
have the patient lying on his back. In this supine 
position, the patient is less able to voluntarily re- 
gurgitate his food than when he is allowed to sit up. 
This is an important clinical fact, because many pa- 
tients who need forced feeding are apt to acquire the 
habit of regurgitating food when they are thus fed. 
This they can do less easily when in a supine position 
than when sitting upright. 

Now in addition to the method of forced feeding, 
to which we have referred, we may state that in feed- 
ing indifferent and unwilling insane patients it is 
always wise to begin by coaxing and persuading the 
sick person in the gentlest and most tactful manner 
to accept food voluntarily rather than to have it 


forced into his stomach. Many a reluctant patient 
will eat when properly and persistently coaxed by a 
skilful and judicious nurse. 

Dietetics. — We come now to a consideration of the 
varieties of food best adapted to those depletions 
and exhaustions which precede and accompany 
mental and nervous diseases. 

Owing to the restlessness and the exhaustion of 
the insane, and to the fact that the life forces wane 
rapidly, and the blood inclines to lose some of its 
natural fluidity, it seems to me that the diet at the 
outset should consist largely of hot liquid foods, and 
principally of milk. The disrepute into which milk 
has sometimes fallen as an article of diet for either 
the sick or the well has arisen from the fact, to a 
large extent, I believe, that it has been administered 
cold instead of warm. Coming from the ice chest, 
or sipped from a glass filled with lumps of impure 
and death-dealing ice, and after being taken from 
diseased cows, it has often been a dangerous diet 
for even the most healthy. When milk is taken cold 
in large quantities it chills the weak stomach of 
the invalid ; it curdles and forms indigestible lumps ; 
and it ferments and brews putrescent gases in the in- 
testines. But when pure milk is brought to a blood 
heat, or a higher temperature than blood, and then 
administered to the worn and exhausted victim of 
disease, it favors digestion and assimilation, and 
prevents, to a very large extent, the evils of cold 
milk to which we have referred. If you have any 
doubt as to the purity of the milk you use, you 
should have it sterilized. This can be done in any 
house by putting the milk in a clean vessel, and 
bringing it up to a heat of 160° F., and keeping it 
there about twenty minutes. This process destroys 


the germs without seriously changing the quality of 
the milk. You should always procure milk which 
has been cleansed by the use of a separator. 

In addition to milk, you may give beef tea, bean 
broth, and chicken, clam, oyster, and other soups. 
You may also give gruels made of oats, and barley, 
and wheat, and rice, and com, and other cereals. You 
may give soups containing much cream, and flavored 
with such vegetables as celery, and lettuce, and 
tomato, and beans or peas; and you will find the 
various concentrated foods valuable aids to treat- 

An exhausted invalid should take food in moder- 
ate quantities, in order to avoid overtaxing the 
powers of a weakened stomach, and after each inges- 
tion of food the organs of digestion should be al- 
lowed to do their work fiiUy, after which a brief 
period of rest may be enjoyed. But this rest should 
not be long continued, for if it is, then exhaustion 
of the patient, through lack of proper and necessary 
nutrition, speedily follows. 

After many experiments, we have concluded that 
a weak insane person should be fed once every three 
hours, from 6 a.m. till 9 p.m.; and if the patient is 
sleepless during the night, then the food may be con- 
tinued every three hours throughout the entire day 
and night. 

Hot milk may, with almost absolute safety, form 
the daily diet and the midnight hypnotic of the 
mental invalid. Should such a food prove too rich 
in some individual case, then the milk may be diluted 
with Ume water, or with clysmic, or seltzer water. 
Should the proportion of cream in milk seem too 
large, then it may be reduced by skimming. Thus 
the amount of fat to be administered to a given pa- 


tient may be regulated, by experience to meet the 
actual necessities of the case. You may also enrich 
milk by the addition of cream when necessary for the 
better nourishment of emaciated cases. The cream 
diet may be improved by whipping up the white of 
an ^^'g with about four times its bulk of cream. 

Aged patients are often benefited by the use of 
buttermilk. In fact, all patients who have easily dis- 
ordered kidneys may be almost invariably benefited 
by the use of firesh buttermilk. 

If you have a patient who is very fat and flabby, 
or who is suffering with dyspepsia, you may begin 
the rest treatment with skimmed milk for two or 
three weeks, in order to allow the useless debris to 
pass away from the system. 

While a hot liquid diet is being administered the 
patient may, if he craves solid food, be treated two 
or three times a day to a slice of toasted stale bread 
of such variety as he may select — that is, either w^hite 
bread, or graham bread, or rye bread. 

After a patient has, by the use of a hot liquid diet, 
fleshed somewhat beyond his normal weight, then he 
may be allowed solid food, consisting largely of the 
various native and imported grains, together with 
vegetables and fruits, and a very moderate supply of 
meat. Rich and stimulating red meat is sometimes 
good for cases of melancholia, but cases of mania 
and general paresis should be restricted as to the 
eating of meat. It sometimes stimulates too much 
those who are excitable and nervous. Meat should 
also be withheld from those who are suffering with 
epileptic insanity. During convalescence, patients 
may take a good deal of fat-producing food with bene- 
fit. It is better for the nervous and the excitable to 
take, instead of much meat, plenty of butter, and 


salad oil, and cod-liver oil. It is always a good plan 
to get the patient fat as quickly as possible, but 
while undergoing the process, a sufficient amount 
of mental stimulus must be applied to keep the brain 
in moderately active working order while the bodily 
recuperation is going on. Thus the danger of demen- 
tia is averted to a considerable extent. 

With the grain foods there may be given an 
abundance of fresh butter and ripened cheese, or 
both. Butter and cheese are simply the concentrated 
products of milk, and they are therefore to be reck- 
oned among the best articles of nutrition for the 
human body. 

Raw or rare cooked eggs go well with milk ; and 
fat bacon or fat spring lamb, with baked potatoes, 
form excellent additions to the dietary used for the 
permanent recovery of the convalescent insane. Fruit 
is allowable in abundant quantities during convales- 
cence. It is said that the ancients when they felt the 
approaches of old age went down into the gardens 
of Hesperides and ate apples in large quantities, and 
thus renewed their youth. 

By such a primary and secondary, or combined 
course of dietetics, the nervous systems of mental in- 
valids are ** renewed like the eagle's"; and also by 
the administration of a moderate daily exercise, in 
conjunction with solid diet, the muscle tissues be- 
come strong again, and ready for active use in the 
customary walks of life. 

Above all things the quality of the food given to 
the insane should be of the best, and its preparation 
for consumption should be made with the anxious 
care of a mother, the delicate tact of a sister, and the 
scientific skill of an accomplished chef. Those who 
prepare food for the use of human beings should be 


earnest students of psychological effects, as well as 
adepts in the esthetics of cookery. The attainment 
of desired results in the preparation and administra- 
tion of food for and to both the sick and the well is a 
lofty and growing ideal, and worthy of the careftd 
study and the critical attention of every one who is 
interested in the prolongation of human life, and in 
the preservation and continuance of health. And the 
food, after it has been prepared as attractively as 
possible, should be served with dainty delicacy. The 
refined air and the scrupulous neatness of a restau- 
rant kept by a Delmonico should be assumed in the 
wards of every hospital, even when only a glass of 
milk is being served to an insane patient. 

Every insane person should have at all times free 
access to fresh water for drinking purposes. Some 
persons who avoid fresh water while in their right 
minds will drink plenty of it when they are insane, 
and it seems to do them a great deal of good. 

Stimulants are rarely needed for those suffering 
with insanity. The brain is in a hypersensitive con- 
dition in such cases, and cannot well endure the 
added irritation which comes from the use of alco- 
holic liquors. Yet there are cases of great debility, 
where the stomach is too weak to retain and digest 
food, where champagne in small doses may be admin- 
istered with beneficial effects. Sometimes brandy or 
whisky may be needed to stimulate the flagging en- 
ergies of a weak and failing heart. But such a 
resource is an infrequent necessity. When stimulants 
are given, only the best and purest articles should 
be employed. 

Moral Hygiene, — Moral hygiene is just as essen- 
tial in the treatment of insane persons as food is nec- 
essary for the mitigation of hunger. Moral hygiene 


consists in transmitting soul encouragement from 
the strong to the weak. Doctors and nurses should 
seek by kind and soothing and stirring words to in- 
spire new spiritual energy in the lives and motives of 
their patients. Many a patient has been erratic and 
undisciplined throughout his life, and it is this lack 
of discipline which often brings a patient to a hos- 
pital for the insane. The establishment of mild but 
judicious direction on the part of those in charge of 
such patients is a prominent portion of their duty. 
Every faculty must be cultivated by means of moral 
hygiene; every emotion must be restrained, and 
every passion must be subdued, in order to enable 
mental invalids to possess that perfect self-con- 
trol which is the loftiest attribute of sanity and 
strength. The gift of administering moral hygiene is 
sometimes a natural one, but even natural gifts may 
be cultivated and strengthened. Hence it is the duty 
of the physician and the nurse to understand one's 
self, to cultivate one's own powers, to be inspired by 
noble purposes, so that the work of transmitting in- 
spirations and disciplinary measures may be suc- 
cessfiil. This is the aim of all modem schools of 


In the treatment of mental disorders, operations 
have been made for the relief of epilepsy, and for the 
relief of traumatic injuries. In some instances pres- 
sure upon the brain may be relieved, but a cure does 
not often follow an operation where epilepsy has 
become firmly established. 

It is thought by some that orificial surgery will 
accomplish much for the insane. Operations for the 
relief of disorders of the distal extremities of the 


digestive apparatus have been performed in numer- 
ous instances, and these operations it is said have re- 
sulted in beneficial effects not only to the local physi- 
cal disorders, but likewise to the general nervous sys- 
tem. Our own experience in these matters has been 
limited. We have relied not so much upon an opera- 
tion as upon position, rest, and absolute cleanliness. 
Rectal diseases are often much relieved by prolonged 
rest in bed, thus relieving pressure upon all of the 
pelvic organs. Hot water, both external and in- 
ternal, aids in relieving chronic congestions and con- 
stipations. The homeopathic remedy, appropriately 
applied, will do its work most thoroughly and satis- 
factorily, when the patient is in bed, and suitably 
cared for by a trained nurse. We had one case where 
the orificial operation was not successful, and 
through disappointment the patient became a victim 
of melancholy. This case was put to bed, and the 
large ulcers around the remnants of his rectum were 
successfully healed, and the patient regained his 
normal mental status. 

We have also had under our notice cases of in- 
sanity in women who have had a part or all of the 
reproductive organs removed by the surgeon. In 
some instances it has seemed that the disease preced- 
ing the operation has tended to mental disturbance, 
while in other instances the insanity has followed the 
operation as an apparent result of shock, hemor- 
rhage, and radically changed physical conditions 
within the human temple. 

I believe that a careful discrimination should be 
exercised by the surgeon in the performance of every 
capital operation, and that the possibility of mental 
disorder following a severe operation should be 
weighed before the undertaking is consummated. It 


has been demonstrated that formidable operations 
maybe performed without much loss of life, but if the 
last state of a diseased victim is to be worse than the 
first, as the result of a grave operation, then it seems 
to me that the wiser course would be to refrain from 
using the knife in such a case. It is possible for a 
woman to live in comparative comfort, and with a 
good deal of serenity of mind for many years even 
when aflGlicted with organic disease of the reproduct- 
ive system, by the adoption of appropriate hygienic 
and dietetic measures, and by scientific medication. 
The simple prolongation of life is not the highest aim 
of the physician or surgeon, especially if it is accom- 
panied with great mental distress. It is better to 
have one year of peacefiil and contented and health- 
fill mind, than it is to have five years of a new life 
with an added burden of an agonizing soul torture. 

In performing a serious operation, the surgeon 
should not only consider the probability of extend- 
ing the life of his victim, but also the probability of 
casting his victim into the toils of protracted, and, 
very likely, incurable insanity. Therefore, before 
making any such operation the surgeon should not 
only consider the physical strength of his patient, 
and her ability to endure the process of carving, but 
he should inquire into the mental antecedents and 
tendencies of his case, and if mental disorder is likely 
to supervene upon his work, he should refirain fi"om 
operating, and seek those mild and less heroic meas- 
ures for continuing life, and, above all, for preserving 
mental peace and health of mind. 

In concluding this lecture on treatment, we wish 
to impress upon your mind the fact that the treat- 
ment of the insane should always be in accordance 
with the loftiest principles of the Hospital Idea, 


which seeks to exemplify everything that can be in- 
spired or suggested by the spirit of kindness or -sym- 
pathy, and which seeks to embody in the line of 
practical utility everything that can be acquired in 
behalf of the sick by intelligent human thought or 
action. The Hospital Idea embraces all that is known 
in sanitary science as applied to the protection of 
human life. It embraces all that is known of dietetics 
as applied to the restoration of impaired physical 
energy; and it embraces the education and train- 
ing of nurses, whose nightly vigils are to supplement 
the daily visits of the physician. The Hospital Idea 
is the loftiest embodiment of that mighty and far- 
reaching rule: **Do unto others as ye would that 
they should do unto you." The Hospital Idea is a 
topic as vast as ocean depths, as magnificent as 
mountain peaks, as enduring as are the experiences 
of sin and sorrow among men. Its application is the 
last and grandest work of the philanthropist and a 
sure forerunner of the millennial dawn. The treat- 
ment of mental invalids is being more and more 
idealized from year to year, and the best methods of 
the general hospital are steadily coming into vogue 
in those institutions designed and used for the care 
and treatment of the insane. 

^ I 



We come now to consider the medical treatment 
of insanity. The malady itself has been described in 
its various forms, and while it is interesting to know 
all that can be learned concerning disease, — concern- 
ing its nature, causes, courses and natural conclu- 
sions, the most intensely interesting part of medicine 
is that which relates to the cure of disease; or, if that 
is impossible, to the relief and comfort of those who 
suffer from incurable maladies. 

Having considered that part of the treatment 
which relates to hygiene, to sanitation, to diet, to 
physical rest and repair, we shall now seek to study 
the art of applying medicine for the cure or relief of 
the insane. Hahnemann was exceedingly particular 
about diet and rest, and the avoidance of all exciting 
causes of physical and mental disorder. But above 
and beyond all these, he laid peculiar and emphatic 
stress upon the curative value of properly selected 
and carefully administered drugs. 

In prescribing a remedy for the cure or relief of in- 
sanity, as for any other disease, we have, as compre- 
hensive physicians, to consider : 

1. The pathological conditions which exist in the 
physical structure. 

2. The mental aberrations which accompany or 
follow the physical disturbance ; and 

3. The totality of symptoms as evolved by a 
careful study of the history of each individual case. 


Again, we find that sometimes a given form of in- 
sanity leads to a specific group of remedies. 

Whenever you are called upon to treat a case of 
mental disease, you should make a careful exami- 
nation — 

1. As to the physical condition of the entire 

2. You should seek to discover all abnormal 
states of the body which may by any possibility lead 
to a disturbance of the mind. 

3. You should seek to discover the various de- 
partures from the normal mental status. (Some 
patients are very cunning, and will deceive the phy- 
sician unless he makes a most thorough and per- 
sistent investigation of the case). 

4. You should make note of all the symptoms 
gathered, and having these as a basis for your pre- 
scription, you should seek to select the indicated 
remedy according to the Law of Similars. 

Let us now turn our attention to a few remedies 
for melancholia. It has long been supposed that 
Aurum Metallicum was a princely remedy for sui- 
cidal melancholia. Our experience has not sustained 
this theory. Aurum has often been prescribed in ap- 
parently indicated cases, but usually without good 
effects. We have a remedy in the Materia Medica 
which has worked very satisfactorily in cases of rest- 
less, resistive, agitated and suicidal melancholia, and 
that remedy is Arsenicum. The patients that Arseni- 
cum has relieved have been those whose physical con- 
dition would naturally suggest the administration 
of that drug. These patients have been much ema- 
ciated, and have had wretched appetites. They pre- 
sent a dry, red, tremulous tongue; they exhibit a 

shriveled skin, and a haggard and anxious counte- 


nance. They look as if they had suffered the tortures 
of the damned, and that the fiends of hell were still 
getting in their fine work. The Arsenicum case is 
very thirsty, but is easily satisfied with a small 
quantity. The Arsenicum patient is not only inclined 
to wear himself out by constant exercise, but he is 
likewise inclined to kill himself, or, failing in that, he 
is apt to mutilate the body by chewing the fingers, 
by pulling out the eyelids, by scratching holes in the 
face and scalp, and by torturing the flesh generally. 
For acute melancholia, where the victim is pros- 
trated by shock, where the grief is intensely pro^ 
found, where the power of weeping, and thus secur- 
ing relief, has been abolished, there we find Ignatia 
Amara the relieving remedy. Probably no drug has 
produced more comforting results in the realms of 
sorrow and of loss than the St. Ignatius bean. The 
Ignatia patient wants to be left alone, and is yet 
sensitive about what she conceives to be the neglect 
of her friends. For brooding sorrow, following hard 
luck or bad news, give Ignatia. For the overmas- 
tering effects of good news, which impel some women 
into the hysteric state, give Coffea. While the Ig- 
natia patient generally broods, she sometimes be- 
comes hysterical, and indtdges in temporary fits of 
laughter. The Natrum Muriaticum patients instead 
ol brooding over their troubles or crying inwardly 
(Ignatia), bubble and boil and shed tears copiously 
like the old prince and king over their alleged dead 
brother, as described in ** Huckleberry Finn." The 
more you attempt to quiet them, the more effusively 
they weep. If contradicted, they become ill-humored 
and easily provoked, like Chamomilla and Bryonia. 
Natrum Muriaticum patients are generally thin and 
anemic, and have a prematurely old age appearance. 


This remedy is often indicated in cases of melancholia 
following intermittent fever, and when the patients 
have periodic attacks of violent weeping. 

Among the cry baby remedies we have Pulsatilla, 
Nux Moschata, and Cactus. The Pulsatilla patient 
weeps easily, but smiles through her tears, and is 
very changeable. The mental state of Pulsatilla is 
like the weather in April, now you see the brilliant 
radiance of the summer's sun as it glints down from 
cerulean-hued heavens; and again, you see gray 
skies, or feel the trickling tears of the clouds. 

The Cactus patient is sad and hypochondriacal; 
not inclined to speak; weeps quietly but steadily. 
And for accompanying symptoms there are marked 
palpitations of the heart, with heavy pressure in the 
head as if a weight lay on the vertex, and pulsations 
in the top of the head. 

Nux Moschata is a remedy for a melancholy per- 
son with hysterical tendencies. The mood is change- 
able; one moment the patient laughs, and the next 
cries. Mental activity under Nux Moschata is 
greatly depressed. The ideas are confased, more so 
than in Pulsatilla, and there is an inability to con- 
tinue a train of thought for any length of time. 
There is loss of memory, and a stupid condition like 
Anacardium, Opium, and Phosphoric Acid. In speak- 
ing or writing, Nux Moschata patients are given to 
dreamy incoherence of expression. 

Digitalis is a remedy that is useful in melancholia 
with stupor, or in any depressed state when the 
pulse is slow, and the general circulation throughout 
the system very stagnant, and when the eyes seem 
to be brimming with tears. 

Gelsemium is called for in melancholia when there 


is much fever, a general dullness of the mental facul- 
ties, and a desire to lie in bed and be let alone. 

Opium is sometimes used in chronic melancholia 
when there is vivid imagination, and when the pa- 
tients are easily frightened; or when there are 
marked stupidity and hopelessness, with contraction 
of the pupils. 

Veratrum Album is called for in melancholia 
when physical prostration and mental hopelessness 
follow an outbreak of maniacal excitement. 

Actea Racemosa, Lilium Tigrinum, and Sepia 
are important remedies in the treatment of melan- 
cholic women who are suffering with ovarian or 
uterine troubles. The mental depression in such 
cases seems to arise from an abnormal condition 
of the generative organs. Both Lilium and Sepia 
are full of apprehensions, and manifest much 
anxiety for their welfare. In the Sepia case, 
however, there is likely to be found some serious 
change in the uterine organs, while the Lilium case 
presents either fiinctional disturbance, or compara- 
tively superficial organic lesion. Lilium is more 
applicable to acute cases of melancholia when the 
uterus or ovaries are involved in moderate inflam- 
mation, and when the patient apprehends the pres- 
ence of a fatal disease which does not exist. The 
Lilium case quite speedily recovers, much to her own 
surprise, as well as that of her friends. The Sepia 
patient is despairing, somewhat suicidal, and averse 
to work or exercise. This remedy is called for most 
frequently in cases of long continued uterine disorder, 
and consequent mental depression. 

Actea Racemosa acts in a more general and less 
specific manner than either Lilium or Sepia. The 
entire nervous system is affected by the use of 


Actca, and the condition produced is that of a 
depressing irritant. The female sexual organs are 
profoundly impressed by this drug. The menses be- 
come erratic and delayed. At the same time the 
patient feels as if her mind were wrapped in a deep 
black cloud. She also feels as if she were going 
crazy, and as if death were impending. Intense 
mental depression, with spasmodic seizures during 
menstruation, headache in the back of the head, ex- 
tending over the neck, with rheumatic pains in the 
muscles of the neck and back, are some of the indica- 
tions for Actea in melancholia. 

We w^ill now consider a few remedies which have 
been used successfully for the cure of mania; and, 
first of all, we will present that medical **01d 
Guard" composed of the **Big Four'' therapeutic 
veterans — ^namely, Belladonna, Hyoscyamus, Stra- 
monium, and Veratrum Album. 

Probably no remedy in the Materia Medica pos- 
sesses a wider range of action, or a greater power 
for relieving distressing symptoms in the brain than 
Belladonna. Its symptoms are clear and well- 
defined. Its action is sharp, vigorous, and profound. 
It is a powerful supplementary ally of Aconite in 
clearing away the last vestige of cerebral conges- 
tion ; and beyond this it subdues effectively the 
subtle processes of inflammation. Its symptoms are 
familiar to every student of Materia Medica, but it 
may be well to state, just here, that in a case of in- 
sanity where Belladonna is indicated you will find a 
hot, flushed face (the face is bright red throughout), 
dilated pupils, throbbing arteries, a fixed and savage 
look, with now and then sudden spasmodic ebulli- 
tions of rage and fury. The Belladonna patient 
tosses in vague uncertain restlessness. He attempts 


to bite, strike, tear clothes, strip oflF clothing, and 
make outrageous exhibitions of the person, not on 
account of lecherousness like Cantharis, but because 
of a disposition to destroy everything that is reach- 
able or tearable. The Belladonna patients are ex- 
ceedingly fickle, and constantly changing in their 
mental states. They change suddenly from one mood 
to another, just as the pain of Belladonna comes 
suddenly and goes suddenly. They sometimes dancei 
and sing, and laugh for a short time. But all their 
moods end in a cyclonic outburst of violence and in- 
tolerable rage. Belladonna produces these conditions 
and symptoms when taken in material doses, and it 
has relieved, and probably cured, many a case of in- 

There are two rather opposite conditions existing 
under the influence of Belladonna. In overpowering 
doses the Belladonna patient, after the first period of 
excitement, becomes dull and heavy, with stertorous 
breathing, and dark-red besotted countenance, some- 
what similar to that of Gelsemium. On the other 
hand, we find other Belladonna cases exceedingly ex- 
citable and nervous, and inclined to move all the 
time. These are the extreme effects of Belladonna — 
either a stupid, apoplectic condition on the one hand, 
and on the other the light, loquacious, active, ex- 
cited, and restless state of mind. The excitable 
patient will become quiet under small doses of Bella- 
donna — that is, from the third to the thirtieth 
potencies, while the stupid patient seems to require a 
large dose — that is, the first centesimal, or even the 
first decimal dilution. 

Hyoscyamus is a remedy that is called for when 
there is a lower grade of maniacal excitement than 
that which calls for Belladonna. The Hyoscyamus 


patient is very exuberant in his expressions, but less 
frenzied than the Belladonna case. Hyoscyamus is 
very talkative, mostly good-natured and jolly. Oc- 
casionally he has savage outbursts, and is inclined to 
be destructive of clothing. The Hyoscyamus patient 
exposes the person because of lecherous thoughts 
and obscene tendencies. In this respect Hyoscyamus 
diflfers from Belladonna. As I have said, Belladonna 
tears oiBF clothing for destructiveness ; Hyoscyamus 
tears oflF clothing for the purpose of exposing the 
person, and for the purpose of exciting the passions 
of others. The Hyoscyamus patient is jolly and in- 
clined to talk very much, and for this reason it is a 
suitable remedy for young, hysterical, nervous, and 
easily excited women. 

The Stramonium patient unites some of the char- 
acteristics of Belladonna, Hyoscyamus, and Vera- 
trum Album. The Stramonium case is even more 
fierce than the Belladonna case. He has laughing fits 
like Hyoscyamus, or rather like a hyena ; he waxes 
eloquent and pathptic in his despairings of salvation 
like the prover of Veratrum Album ; and he is also 
greatly troubled with hallucinations. Everything 
seems to be dark before his eyes. He swears at and 
makes threats against imaginary foes. He has 
periods when he is ready and "spoiling for a fight." 
But for the most part, the Stramonium case is an 
arrant and crouching coward. He sees animals, of 
strange varieties and gigantic proportions, leaping 
at him from the floor or the side-walls, and he is 
greatly terrified by these apparitions. 

Now remember this group of facts : Belladonna is 
fierce and brave; Hyoscyamus is jolly and compan- 
ionable; Stramonium is wild and cowardly; Vera- 
trum Album is hopeless and despairing, or wildly 


plaintive, and beseeching for his salvation, which is 
apparently lost. 

Veratrum Album is a remedy whose sphere of use- 
fiilness comprehends both profound prostration of 
the physical forces, and a most shattered condition 
of the intellectual faculties. The fame of this drug- 
extends over a period of more than three thousand 
years. It is related that about the year 1500 before 
the Christian Era, a certain Melampus, a celebrated 
physician among the Argives, is said to have cured 
the daughters of Proteus, King of the Argives, who, 
in consequence of remaining unmarried, were seized 
with an ** amorous furor'* and afiected by a ** wan- 
dering mania." These women had what is now 
called **old maid's insanity." They were cured 
chiefly by means of Veratrum Album given in the 
milk of goats which had been fed upon that plant. 
We have verified the use of Veratrum Album in 
** wandering mania," especially when the symptoms 
of peculiar excitement and tendency to travel are 
accompanied by great mental distress and physical 

The Veratrum Album patient combines, as pri- 
mary effects, the wildest vagaries of the religious en- 
thusiast, the amorous frenzies of the nymphomaniac, 
and the execrative passions of the infiiriated demon^ 
each striving for the ascendency, and causing the un- 
fortunate victim to writhe and struggle with his 
mental and physical agonies, even as the dying Lra- 
ocoon wrestled with the serpents of Minerva. This 
anguish is short-lived. The patient soon passes from 
an exalted and frenzied condition into one of pro- 
found melancholia — abject despair of salvation, im- 
becile taciturnity, and complete prostration of both 
body and mind. The extremities become cold and 


blue; the heart's action is weak and irregular; the 
respiration is hurried, and all the objective symptoms 
are those of utter collapse. The physical state is like 
that of a case of cholera. At the same time the mind 
passes into a stygian gloom from which it slowly, if 
ever, emerges. With such a picture before us we can 
scarcely hesitate in the choice of a remedy, and 
Veratrum Album is the one to be selected. There 
are, of course, cases which are past the grace of med- 
icine, yet the earnest use of this long tried drug has 
frequently repaid us by marked improvement follow- 
ing its administration, and in some cases Veratrum 
Album has seemed to complete the cure. 

We have portrayed a few characteristic symptoms 
of four drugs for the cure of insanity of the maniacal 
form. We might add to the list Aconite, with its 
high fever, its mental anxiety, its restlessness and 
fear of death. We might also speak of Veratrum 
Viride which has likewise an exalted temperature, a 
rapid pulse, great restlessness, fear of being poisoned, 
and yet withal an indifference to death, w^hich is in 
sharp contrast with the mental state of Aconite. 
Veratrum Viride is often indicated in the maniacal 
attacks to which epileptics and paretics are subject. 

Again, we might speak of Nux Vomica, which is a 
valuable remedy in subacute mania, where the pa- 
tient is suspicious, and indulges in delusions of perse- 
cution and wrong. The Nux Vomica patient is obsti- 
nate, incorrigible, cross, ugly, and sometimes studi- 
ous. Bryonia is also an ugly remedy. The Nux 
Vomica patient moves about, while the Bryonia pa- 
tient keeps still because all his symptoms are aggra- 
vated by motion. 

We might also speak of Lachesis, which is a 
remedy for those who are extremely sensitive and 


persistently loquacious, and who indulge in the 
strange and fantastic idea that they are dead, and 
that preparations for the funeral are going on. The 
prover of Lachesis feels as if death had overtaken 
him, because of the profound and depressing effects 
of that powerful drug. The blood rot of Lachesis is 
only outrivaled by the blood rot of Baptisia Tinc- 
toria. The victim of the latter thinks that he is all 
to pieces and scattered about, while Lachesis only 
thinks that he is dead, and gathered to his fathers. 

Rhus Toxichodendron is of service in acute mania 
when there is a rheumatic history, an excessive 
restlessness at night, and when the patient is pos- 
sessed of strong delusions of being poisoned. (Also 
Hy oscyamus and Veratrum Viride) . 

Tarantula is a remedy for crafty, cunning mani- 
acs — ^patients who are full of mischief, and prone to 
sudden fits of destructiveness, such as knocking 
down pictures, or sweeping bric-a-brac from a man- 
telpiece, or pounding a piano, or a helpless chUd. 

Sulphur is useful in mania as an intercurrent 
remedy. Also for ** fantastic mania" when the pa- 
tient decks himself with gaudy colors, and puts on 
old rags of bright hues, and fancies them the most 
elegant decorations. Sulphur seldom achieves a cure 
by itself, but sometimes it seconds with vigor the 
efforts of other drugs. 

When there is great sexual excitement in mania, 
it may be relieved by the use of Cantharis. The 
Cantharis patient has frenzied paroxysms of an ex- 
alted type like Belladonna. The victim of this 
remedy bites, and screams, and tears his hair, and 
howls like a dog. As an invariable accompaniment, 
there is also great excitement of the sexual organ- 
ism. In this latter respect, Cantharis resembles Hy- 


oscyamus and Veratrum Album, but these latter 
drugs commingle the psychical with the physical, the 
Hyoscyamus patient displaying lively fancies in con- 
nection with erotic desires, and the Veratrum Album 
patient uniting religious sentiment with lustful ten- 
dencies; but the Cantharis patient, on the other 
hand, is strictly and solely the embodiment of lechery 
for lechery's sake. This is a result of an intense 
erethism and inflammation of the sexual organs, im- 
pelling the victim to seek immediate physical gratifi- 

Cases of dementia may require Anacardium if the 
patients are inclined to swear ; Apium Virus if the 
skin is puffy and smooth, and when there is inac- 
tivity of the kidneys; Calcarea Carbonica, when 
patients are fat, flabby and pale; Calcarea Phos- 
phoricum, if there seems to be a tendency to cere- 
bral chilblain; and Phosphoric Acid when the pa- 
tients are dull and drowsy, with occasional periods 
of excitement, and profuse discharge of urine. In 
cases of profound mental depression and mental 
obfuscation — conditions which suggest both melan- 
cholia and dementia — when the nervous system is 
greatly exhausted, and when there are hysterical 
tendencies, and when the flow of urine is very pro- 
fuse. Phosphoric Acid is a leading remedy. 

In masturbatic dementia we give Agnus Castus, 
Causticum, Cantharis, Damiana, Picric Acid, Phos- 
phorus, Phosphoric Acid, Staphisagria, Nux Vomica, 
and Opium. 

In epileptic dementia we sometimes find Bella- 
donna, Cuprum Aceticum, Laurocerasus, CEnanthe 
Crocata, and Solanum Carolinense of service in re- 
lieving unfortunate symptoms. CEnanthe Crocata 
has done much good in the relief of epileptic in- 


sanity. Solanum Carolinense has been used, but its 
effects seem to be cumulative, and while the fits may 
be checked for a season, they return with renewed 
vigor, and in a dangerous way. Silicea, thirtieth, has 
been one of the most satisfactory remedies in effect- 
ing a wholesome change throughout the general phy- 
sical system of the patient. As a health-developer 
in epilepsy, Silicea ranks. as one of the first remedies 
on the list. In medicating epileptics, you should be 
carefiil and not overdo the work, and refrain from 
giving too much medicine. You should regulate the 
life, the diet, and the exposure to heat and wind. 
You should encourage the individual to a philosophi- 
cal and natural state of living. You should provide 
against the injury of the patient during fits, by cov- 
ering everything that is hard, and by lining and pad- 
ding everything which he is likely to strike. All 
sharp corners should be removed or covered in the 
room where the epileptic lives. His diet should be 
plain, w^holesome, light, and not stimulating. If you 
give large doses of medicine and subdue or conceal 
the fits for a time, you subsequently find that you 
have simply postponed the evil day. You have 
worked cumulative damage to your patient, and you 
have perhaps driven an otherwise quiet and harm- 
less case into the toils of maniacal excitement, or in- 
to the deepest and most damnable depths of de- 

For the relief of general paresis, we may suggest 
Mercury in its various forms. Nitric Acid, Iodide of 
Potash ; Sulphur and Aurum if syphilis is suspected ; 
and for the relief of the epileptiform seizures, Vera- 
trum Viride, Cimicifiiga, Cuprum Metallicum, and 
Laurocerasus. For the intense restlessness, anxiety, 
and expansive ideas, together with rapid emaciation 


of strength and flesh, you may use, according to the 
symptoms, Aconite, Arsenicum, Belladonna, and 
Cuprum. Alcohol produces artificial and temporary 
paresis, and is therefore homeopathic to the genuine 
article. It may be administered in small doses some- 
times with benefit. Good whisky, in one-half ounce 
doses, may be given once in three or four hours when 
necessary. These remedies have thus far not proved 
curative, but have sometimes afforded relief, and 
have seemed to effect a prolongation of life, and an 
increased comfort to the sick one. 

Hospital Construction 

During the past quarter of a century State hos- 
pitals for the care and treatment of the insane under 
homeopathic methods have been established in the 
commonwealths of New York, Massachusetts, Min- 
nesota, Michigan, California, and Missouri. There 
should be a public homeopathic hospital for the care 
of the insane in every state of the Union, because 
there are believers in that school in every state. 
Homeopathists pay a considerable proportion of 
the taxes in each state. If they are denied the privi- 
lege of homeopathic treatment when in mental dis- 
tress, they are suffering not only with disease, but 
likewise from the condition of taxation without 
representation. Again, freedom of choice in medical 
matters is a privilege that is just as sacred to the 
individual as freedom of choice in any form of relig- 
ious worship. In order to secure representation 
wherever there is taxation, and in order to secure 
absolute freedom of choice in medical matters, you, 
as physicians, should seek to establish in the state 
where you live a public hospital where mental in- 


valids may be treated in accordance with homeo 
pathic principles. 

In attaining this desired end, you should consider : 

1. A suitable site for the proposed hospital. 

2. The economical and durable construction of 
both large hospital buildings and cottages for the 
accommodation of the various grades of patients. 

3. Ventilation, heating, and lighting. 

4. Protection against fire. 

5. Furnishings and decorations. 

6. Congregate and ward dining-rooms. 

7. Kitchen and bakery building. 

8. Boiler-house, dynamo plant, and laundry. 

9. Cold storage building for general supplies. 

10. Outbuildings for stock of various kinds. 

Site. — In selecting the site for a hospital you 
should seek the moderate hilltops or sunny slopes of 
protecting mountains, although you should at the 
same time consider the difficulty of getting coal, 
water, and provisions to their destination without 
unnecessary expense. You should, if possible, locate 
the buildings in such a place that you may have rail- 
road communication direct to the institution; thus 
the hospital will be siibjected to no heavy expense 
for long cartage of coal, or other materials. A little 
oversight on this point would lead, perhaps, to a 
subsequent expenditure of thousands of dollars per 
year, and without any real necessity for it. 

Sites suitable for good sanitation must be at- 
tained, but to these may properly be added the in- 
spirations of grand and stirring scenery of either the 
summits or the surf. Patients who are convalescing 
from insanity are stimulated and helped to recovery 
by the beauty or grandeur of the environments 
which nature throws about them. It is said that 


sea air has a soporific influence upon patients suffer- 
ing with mania, \srhile the air and scenery of the 
mountains are most inspiring and beneficial to the 
victims of melancholia. 

The soil of the site selected should be dry and 
porous, or if it is a stiff clay, it should at least be 
amenable to the influence of good drainage and culti- 

Buildings, — The buildings designed for the care of 
the insane should be located due north and south, or 
a little east of south, in order to secure throughout 
the year as much sunshine as possible upon the east, 
south, and west sides of the buildings. 

After many experiments, it has been determined 
that hospital buildings for the insane should be not 
more than two stories in height. The buildings 
should be of moderate size, each accommodating 
from twenty to one hundred and fifty patients. 
Buildings of moderate size can be furnished with 
light and fresh air more readily than large buildings, 
and patients can be more easily classified in small 
buildings than in large ones. 

A public institution designed for the accommoda- 
tion of twelve hundred or fifteen hundred patients 
may properly consist of a series of buildings of mod- 
erate size, and these, for convenience of access, and 
for the ready distribution of food, may be connected 
with each other by suitable corridors. If the site is 
large enough, it is well to erect the buildings on the 
borders of a large rectangle or parallelogram. With- 
in the general enclosure of buildings and corridors 
designed for patients may be situated a boiler-house, 
a dynamo plant, a laundry, a kitchen and bakery, 
an entertainment hall, and a library. In this 
country, where changes in the weather are frequent 


and at times very pronounced, it is better to have 
the institution so constructed that the patients may 
go from all the wards to the library and the enter- 
tainment hall and chapel without being obliged to 
suflFer any exposure in the open air. By means of 
suitable corridors from one building to another, the 
officers and employees are also protected in the dis- 
charge of duty from unfavorable weather. 

The buildings should be constructed of brick with 
hollow walls, and they should be sufficiently strong 
for all practical purposes. The floors should be built 
of steel girders and brick arches, overlaid with tile in 
the water-sections, and paneled oak or body maple 
in the wards. The ceilings should be of steel fash- 
ioned into bright and attractive patterns, or the 
brick arches may be plastered and painted. The side 
walls should be of adamant cement, and every comer 
should be made a quarter-round. 

Each building should have a basement not less 
than nine feet in height, and it should come well out 
of the ground, in order that it may at all times be 
supplied with fresh air, and as much sunshine as pos- 
sible. The floor of the basement should be of cement 
or stone. The basement floor should be laid in a 
sloping fashion toward the drain, so that the base- 
ment may be cleansed by hosing water over the 
floors and into the drain pipes. 

The hospital building should be divided into large 
rooms, each containing thirty to seventy-five or 
more beds. A few single rooms should be provided 
in each hospital building. The hospital or reception 
wards should be spacious and airy, with high ceil- 
ings and numerous windows. Every hospital ward 
should be provided with a solarium, or sun-room, 
where the patients may secure the beneficial effects of 


sunlight and fresh air at all times, and under the 
most favorable circumstances. The open wards may 
contain most of the patients, while the single rooms 
can be used for the disturbed or the very sensitive. 
Each ward should have easy access to a tower con- 
taining baths, lavatories, water-closets, urinals, and 

If it seems necessary to isolate some very dis- 
turbed cases, they may be placed in one-story hos- 
pital buildings detached from the main structures. 
These buildings should be thoroughly lighted and, if 
necessary, skylights, as well as side-lights, may be 
used. But there are very few disturbed cases nowa- 
days who do not become quiet more quickly if as- 
sociated with others than if kept in absolute seclu- 
sion. The seclusion of the noisy and the violent 
should be only a temporary matter. We think that 
at least sixty-five per cent, of the acute insane 
may be properly treated in large hospital wards in 
association with each other, and where trained 
nurses may have their eyes upon all the patients all 
the time, both day and night. By such means the 
patients get constant nursing, and the method is 
economical, as a nurse can take better care of half a 
dozen patients if they are in one room, than he of can 
three patients if they are isolated in single rooms. It 
is thought by some that when a large number of pa- 
tients are placed in one ward they will disturb and 
annoy each other. This supposition is not founded 
upon fact, because each patient is so absorbed in his 
own thoughts that . he pays but little heed to the 
thoughts and expressions of others. Hence the in- 
sane do as well when they are in hospital wards as 
when they are confined in small single rooms ; in fact, 

it seems to me that the majority do better under the 


conditions of association. Occasionally there is a 
patient who does not harmonize with his fellows, or 
even tolerate them, and in such a case a small pri- 
vate room should be afforded. Each person should 
be considered from an individual standpoint, and he 
should be favored with such surroundings as are 
most likely to insure his speedy recovery. When pa- 
tients begin to convalesce, they sometimes desire to 
seek the seclusion which is afforded by a single room. 
When they have secured all the benefits of treatment 
in a general hospital ward, then they should be 
granted the privilege of a room by themselves, or a 
room in which two or three patients can be happily 

Patients who have partially recovered in recep- 
tion wards may be transferred to other suitable 
wards, or to cottages w^hich are adapted to the care 
of such cases. In wards and cottages for convales- 
cent and recovering patients, it is often feasible to 
practice what is called the ** open-door system." The 
doors are unlocked during the daytime, and the 
patients go out and come in at their pleasure, after 
their tendencies have been observed, and their trust- 
w^orthiness ascertained as fully as possible by the 
attending physician. No patient should be permitted 
to have an unrestricted parole until his mental con- 
dition is such that he can appreciate the benefit and 
feel the responsibility of such freedom. 

If the hospital buildings are two stories in height, 
then the floors should be thoroughly deafened, in 
order to prevent the patients on the second floor 
from disturbing those on the first, by shouting or 
dancing above them. 

Ventilation^ Heatingj and Lighting, — There are 
several methods of enforcing ventilation in a hospital 


^Bvard, but the sum and substance of them all is em- 
bodied in the one word "draught." The foul air 
must be made to move out, and the fresh air must be 
made to come in, and these exchanges of impure for 
pure air all depend upon the laws of motion. 
The vital questions to be decided are : 

1. How swift shall be the current of moving air; 

2. How frequently shall the air in a hospital be 
entirely changed ? 

A rapid draught may cause discomfort, or even 
dangers to the patients. Rapid draughts of cold air 
induce attacks of influenza, bronchitis, and pneu- 
monia. If the volume of air moves too slowly 
through a hospital ward, then there is danger that 
some of the impurities may remain, and thus pro- 
duce disease. It is claimed that the best and safest 
rate of motion of air in a ward is about two miles 
per hour. Much, however, depends upon the condi- 
tion of the air itself— its temperature, and its humid- 
ity. In summer ventilation may be secured through 
windows and doors. The best method of window 
ventilation is to raise the lower sash about six or 
eight inches, and let down the upper sash about the 
same distance. Much of the impure air is lighter 
than common air; hence these impurities escape if 
the upper sash is lowered. The currents of fresh air 
coming in through the lower opening facilitate the 
transmission of foul air to the upper regions. Some- 
times the air becomes laden with carbonic acid gas, 
and this being heavier than common air settles to 
the floor. In removing this heavy foul air, the ad- 
vantages of doors and French windows are plainly 
apparent. With a door on one side of the room and 
a French window on the other, the foul air that is 


heavier than common air is easily swept away. The 
best ventilation by means of windows and doors 
would be secured if each room or ward were supplied 
with long doors on one side, and French windows, 
on the other. These, when opened wide, favor the 
free passage of air, and if there are enough of these 
windows the atmosphere in a ward soon becomes 
like the atmosphere out-of-doors — entirely pure, and 
free from odors. 

It should be the aim of all who are in charge of 
hospitals for the sick to keep the air of the wards as 
pure and fresh as that which is uncovered by any 
roof, and which has been made fresh and invigorat- 
ing by the cleansing blows of the pelting storm, and 
the actinic rays of the noonday sun. 

In winter the proper ventilation of wards and 
hospitals is a more difficult task to accomplish than 
during the summer. During the cold season ventila- 
tion must be associated with the heating apparatus. 
Fresh air should be sent into the wards by passing it 
over hot steam coils or pipes filled with hot water. 
Foul air must be taken away through conduits ex- 
tending to the attic, and these should be connected 
with a large cylinder supplied with steam pipes, to 
rarify the air and produce a draught ; and above the 
cylinder there should be constructed suitable ventil- 
ators for the exit of the impure and exhausted air ol 
the wards. By means of a suitable steam-heating 
apparatus, fresh air may be driven into the wards 
constantly'', and foul air may be drawn out of the 
wards by the means already referred to. The impure 
air is rarified by heat, and drawn up through pipes 
or hollow tubing, until it reaches the peak of the 


attic, and thence it passes into the open air through 
suitable ventilators. 

While the air in a hospital ward can be properly 
heated and systematically distributed, and while the 
impurities, as a rule, may be drawn up and forced 
out at the top of the building, yet we believe that 
the French w^indow and the open-door system of 
changing absolutely and completely all the air in the 
ward should be resorted to from time to time. By 
the ordinary processes of heating and ventilation, 
the air is, for the most part, kept in a fairly pure 
state ; but some of the fresh air is constantly coming 
in contact with the impure air which has not yet 
wholly departed, and consequently there remain, 
even in a w^ell- ventilated ward, some of its native and 
inherent impurities. These can be removed only by 
an absolute, speedy and complete change, by open- 
ing all the sides of the house, so to speak, at suitable 
intervals — that is, by opening the French windows 
and the doors. 

The heating of a hospital building may be carried 
on by the indirect method, or by the direct-indirect, 
or by the direct method. By the indirect method the 
steam coils are all kept in the basement, and thus 
space is economized in the ward. The indirect 
method is best for violent, or disturbed, or epileptic 
patients, as such patients are less liable to be injured 
by the indirect method of heating than by the direct. 
When the radiators are in the wards the epileptic 
patients almost inevitably fall upon them when hav- 
ing fits; and now and then a violent patient will 
attack a radiator when it is hot as if it were an 
enemy, and in that way he gets burned. 

The direct-indirect method of heating is a combi- 
nation of direct heating, and ventilation from out of 


doors. The same objections apply to it as to the 
direct method. 

The indirect method is probably the best, except 
that it may have to be supplemented in cold corners 
of the building by carrying the steam direct to these 
exposed points. The steam-heating of hospital build- 
ings has been carried to a very satisfactory pitch of 
perfection, and this method of heating will probably 
continue until superceded by electricity. 

Some prefer the hot water method of heating, but 
this system requires an excessive amount of large 
pipes, and these occupy much space, and that would 
be a serious objection if it were desirable to use the 
direct method of heating. In case a pipe breaks in a 
system where hot water is used for heating, the 
flooding of the rooms and wards might be an addi- 
tional objection. 

Every hospital should be abundantly supplied 
with sunlight during the day, and to this end large 
windows and plenty of them are needed. During the 
evening the wards should be favored with an ample 
number of electric lights. These lights should be 
covered with suitable shades, to protect the eyes of 
the patients. Except during the sleeping hours, all 
gloom should be dispelled as far as possible by the 
introduction of light in almost unlimited quantities. 
Darkness favors a continuance of gloomy thoughts, 
while light tends to restore hope and happiness to 
the human soul. 

Protection Against Fire. — Every hospital should 
be scrupulously protected against the ravages of fire. 
Such protection is a prime necessity. In each large 
public hospital there should be a well organized fire 
brigade. The members of this brigade should con- 
sist of those who work in the engineer's department, 


and of the attendants and nurses who work upon 
the wards. They should be regularly drilled at fre- 
quent Intervals in the handling of apparatus to be 
used for the putting out of fires. 

There should be in each hospital a system of elec- 
tric fire alarms, so constructed as to reveal, at the 
outset, the exact location of the fire. There should 
be an abundant water supply for fire purposes, and 
it should be distributed by means of pipes through 
every ward, and by means of hydrants on every side 
of each building exteriorly. Each institution should 
have a hose house, with an abundance of hose rolled 
upon carriages. Everything that is needful for the 
speedy attachment of the hose to the hydrants, in 
case of conflagration, should be furnished, and kept 
in the most convenient place. A portable chemical 
fire engine is also a desirable addition to the fire ap- 

In addition to the foregoing, each ward of each 
building should be supplied with portable fire extin- 
guishers of approved pattern and tested capability. 
Hand grenades, fire pails, water in barrels and tubs 
should also be provided, and within easy reach of the 
employees, especially at night. 

Above and beyond all the measures heretofore 
suggested, we believe that a system of automatic 
fire sprinklers should be installed in every room, and 
every ward, and every basement, and every attic of 
every building devoted to the care of the Insane. 
The greatest horror that can befall an institution 
where the helpless sick Is housed is the calamity of 
fire. It is almost Impossible to put out a fire when 
once fairly started. Each ventilating shaft, or 
clothes chute, or elevator passageway, becomes, in 
the hour of fire, a chimney through which the flames 


are forced with a draught that equals the most elab- 
orate and scientific boiler-house smoke-stack. Hence^ 
when a fire is once started, it is, as we have re- 
marked, almost impossible to check it. Therefore, it 
becomes our duty to prevent fires rather than to in- 
dulge in the almost useless task of trying to put 
them out after they are once started. Every new 
building designed for the care of the insane should be 
protected by a method known as the "automatic 
fire extinguishing system.'' This system consists of 
a series of pipes which pass to every ward and room 
in each building. At proper intervals these auto- 
matic sprinklers are placed, and when any one of 
them is brought to a heat of 160°F., a cap, which 
is held in place by soft solder, is released, and 
a most vigorous diffusion of spray follows. This 
spray strikes the ceiling, the side-walls, and the 
floors, and is generally successful in extinguishing all 
incipient fires. This system does not rely upon the 
tardy discoveries of a sleepy night-watch, but it 
works without direction or command, vigorously 
and effectively whenever and wherever the first 
flames of a kindling conflagration bring the heat 
of a room or hall to 160°F. The automatic fire 
sprinkler is probably the best and safest means for 
the prevention of large fires, by putting out the small 
ones while they are yet in an incipient stage of de- 

There should also be provision made in every hos- 
pital for the speedy and safe escape of inmates from 
the buildings in case a fire should occur. If future 
structures designed for the insane shall be only two 
stories in height, then the danger from fire will be 
lessened. But in any event, it is wise to prepare 
beforehand for every possible disaster. We have 


examined into the merits of several varieties of fire 
escapes, ranging 'from the simple [iron ladder to an 
elaborate and wire-protected iron stairway. Down 
the latter, when wide enough, sick patients may be 
carried on cots, if they are unable to walk. But a 
fire escape composed of iron "treads and risers" is 
liable, in time of fire, to be filled with smoke and 
flame, in which case it is almost impossible to utilize 
it in those conditions. 

Probably the best fire escape is a cylinder of steel 
about six feet in diameter. The outer shell is com- 
posed of steel plates tightly riveted together. With- 
in is a spiral chute. This chute is fastened to and 
supported by the external cylinder. In the center 
is an iron pipe which may be used as a conduit 
for water. The chute is fastened centrally to this 
pipe. The cylinder is attached to the building in 
such a way as to be easily accessible from each 
floor. Down this steel spiral structure patients may 
slide very rapidly without danger to themselves or 
others. It is said that one hundred persons may 
escape from a burning building in one minute 
through a chute of this kind. People enter the 
cylinder by passing through two iron doors, one 
closing behind the person before the second is opened. 
This keeps back the smoke and flame to a very large 
extent. If the fire reaches and heats the cylinder at 
any point, it may be cooled from without by the ap- 
plication of a stream of water. 

Pamisbings and Decorations. — Th^ furniture for 
the use of the insane should be strong but comfort- 
able, and of a pattern that will appear neat, that 
can be readily cleaned, and that will not harbor 
vermin. The bedstead should be of iron with woven 
wire spring; and the mattress should be either of the 


best of hair, or the best of cotton felt. The cotton 
felt mattress of proper quality is pliable and soft, 
and does not get lumpy or mat like a hair mattress. 
For these reasons the felt mattress seems to me to be 
the most appropriate for bed patients. Patients 
who are constantly in bed upon hair mattresses are 
apt to have their skins irritated by the occasional 
protrusion through the mattress of a sharp end of a 
stiff and half-curled hair. This does not occur when 
the best of elastic cotton felt is used. 

Each hospital should be furnished, aside from a 
bed and table for each patient, with large, easy rock- 
ing chairs, and invalid chairs. We do not, however, 
advocate the use of upholstered furniture, except in 
the sitting-rooms of wards for the accommodation 
of convalescent patients; for the reason that it is 
quite easily soiled, and the expense of keeping it in 
good condition is therefore considerable. 

The furnishings and decorations of each room 
should constitute an harmonious individuality by 
itself, and yet all the rooms should be made to 
harmonize with the ward. We think that the walls 
should be painted in light colors, because they are 
more soothing than dark colors. Pictures should 
be placed upon the walls, and curtains at the win- 
dows of both sitting-rooms and bed-rooms. A mis- 
taken notion prevails that insane patients often 
destroy such furnishings, but experience has tended 
to prove the contrary. Only a very small percentage 
of such patients destroy beautiful furniture or fur- 
nishings. Rugs are preferable to carpets, as they 
are more easily kept clean. Furnishings of a bright 
and inspiring character not only tend to the beautify- 
ing of a ward, but they may be classed as positive 
curative agents. The lively interest which the pa- 


tients take in any ne^w furniture that is placed upon 
a ward is sometimes really remarkable. 

Congregate or Ward Dining-rooms. — Much has 
been written during the past twenty years about 
associate or congregate dining-rooms. In institu- 
tions having two thousand or three thousand pa- 
tients, the interests of economy are conserved by 
erecting large dining-rooms convenient to the wards, 
and also adjacent to the kitchen building. Thus the 
food may be served hot and promptly, with the 
smallest practical number of attendants. These large 
dining-rooms are very convenient and satisfactory 
for the chronic insane who are able to be up and 
dressed, and who can easily w^alk from the ward to 
the dining-room; but for patients suffering with 
acute insanity, who are obliged to remain in the hos- 
pital wards, and much of the time in bed, the con- 
^egate dining-room is, it seems to me, unavailable. 
Attached to every hospital ward should be a con- 
venient pantry and a small dining-room, where the 
food may be quickly served when sent from the 
kitchen. In every hospital for mental invalids there 
is quite a considerable number of patients who are 
sensitive as to their surroundings. These should be 
placed on wards of moderate size, and there should 
be a small dining-room attached to each one of these 
wards. These patients may then be classified in such 
a manner as to best conserve their general welfare, 
and make them as happy as possible. A dozen con- 
genial patients may sit down at a table in a small 
room and enjoy their meals, \srhile if they w^ere forced 
to eat in a large congregate dining-room, \\rhere the 
table manners of some are highly objectionable, they 
would be unable to take food in sufficient and sat- 
isfying quantities. I believe that every institution 


should be provided with large dining-rooms and 
small dining-rooms, arranged in such a manner as to 
insure the best interests and the greatest possible 
comfort of all concerned. 

The objection to small dining-rooms is that they 
require more help in the aggregate than the large 
dining-rooms. But these small dining-rooms can be 
looked after in such a manner as to be reasonably 
economical in their management. The attendants in 
small dining-rooms as soon as their work is finished 
(and that is quickly done by the help of patients) 
may then engage in the task of exercising patients 
out-of-doors, and in performing such other duties as 
may properly be assigned to them. 

Kitchen and Bakery Building. — The kitchen and 
bakery building should be separate from all other 
buildings, aside from store rooms and cold storage. 
There should be a narrow corridor connecting this 
building with the basements of the other hospital 
structures, and through which the food car may 
pass. The kitchen and bakery building should be 
large, light and roomy, and as nearly as possible fire 
proof. The floors should be of Portland cement, 
put down upon a solid and unchanging founda- 
tion. The building should be so arranged as to re- 
ceive all raw material at one side of the structure, 
and the food, after it has been prepared, should be 
sent out to the wards from the other side of the 
building. The scullery should be so situated that all 
soiled utensils coming back from the wards may be 
washed before they get to the kitchen or bakery 
again. The kitchen furniture should be capacious 
enough for all possible needs of the hospital ; and the 
boilers and ranges should be set up in such a manner 
as to be convenient of access to those who must pre- 


pare the food. Lack of room in the cooking estab- 
lishment of an institution, or inconvenience of ar- 
rangement, will tend to produce unnecessary strain 
upon the workers, and this will finally result in 
carelessness in one of the most important of all hos- 
pital tasks — namely, the proper preparation of food. 

Boiler-bouse, Dynamo Plant, and Laundry. — The 
various buildings for heating, lighting, and laundry 
work should be commodious and convenient. The 
tendency at the outset is almost always toward a 
too rigid economy, and a miserly stringency of space. 
It is unwise to put up small buildings for an institu- 
tion which may in time, by the addition of various 
wings and wards, come to accommodate two thou- 
sand or more patients. These necessary adjuncts to 
hospital wards should be made fire proof and they 
should be situated in the rear of the main building, 
and as nearly as possible in the center of the inner 
court— that is, if the hospital wards are grouped 
about a large rectangle. If the linear plan of con- 
struction is pursued, then these various buildings 
should be in the rear of the main or administrative 
building. For purposes of safety, and to avoid an- 
noying the sick, the boiler-house, d3mamo plant and 
laundry should be located at least three hundred or 
four hundred feet from the wards. 

Cold Storage Building. — ^A cold storage building 
is now considered an essential necessity for the 
preservation of meat, milk, butter, eggs, vegetables, 
fhiit, and other perishable articles. With a cold stor- 
age the authorities of an institution may take ad- 
vantage of low market rates at certain seasons of 
the year, and lay in a large supply as cheaply as 
practicable. This building should be convenient of 


access to the kitchen and bakery, and large enough 
to hold a three months' supply of food at the least. 

Outbuildings for Stock of Various Kinds.— It 
seems to be the policy of the various states to have a 
farm in connection with each State hospital, hence 
there is a necessity for bams, and stables, and pig- 
geries, and other buildings for the accommodation of 
the various kinds of stock. The task of caring for 
horses, cows, pigs, chickens and ducks may be carried 
on successfully by the aid of convalescent and intel- 
ligent patients. These outbuildings should be located 
so far away from the hospital that they cannot be- 
come sources of annoyance to the patients. 

The task of upbuilding a public institution for the 
insane is a noble and a glorious one. It is an under- 
taking worthy of the attention, the careful contem- 
plation, and the best energies of any thoughtful man. 
The upbuilding of an establishment, whose outlines 
we have endeavored very briefly to sketch, is an 
enterprise so lofty in purpose, and so beneficent in 
results as to afford serene satisfaction to all who 
may engage in the work. 

In the heart of London, England, there stands a 
magnificent structure known as St. Paul's Cathedral. 
The architect of this gigantic and stately edifice was 
Sir Christopher Wren. When his great work was 
completed, he inscribed upon the rim of the grand 
dome in the center of the cathedral this word, ** Cir- 
cumspice,^^ which means in plain English, "Look, 

When the modem hospital is completed upon the 
plans outlined in this lecture, then all the people 
maybe invited to "look around," and behold with 
pleasure the results attained when benevolence and 
philanthropy, enlightened intelligence and enthu- 


siastic energy, unite their forces for the purpose of 
effecting that which is best in the care and comfort 
and cure of mental invalids. 


We present herewith, alphabetically, a list of rem- 
edies for taental disorders, with characteristic mental 
and allied symptoms. 


General Action, — Aconite affects primarily the 
cerebrospinal and sympathetic ganglionic systems. 
It stimulates the inhibitory centers of the pneumo- 
gastric, and by hyperstimulation the pneumogastric 
nerve becomes exhausted, as is shown by the heart's 
action becoming quickened and more irregular, until 
finally paralysis of the heart may occur. Aconite, 
when given in large doses, produces inevitable cardi- 
ac depression and a tendency to death. In less 
poisonous doses, this drug produces acute inflamma- 
tory action throughout the system. The precise 
manner in which the inflammatory process is in- 
duced by Aconite has not been satisfactorily ex- 
plained, but it has been suggested that by causing 
paralysis of the vasomotor nerves, the arterioles 
dilate, doubling their capacity, and thus patients are 
bled, so to speak, in their own vessels. Wherever 
there is an excessive supply of blood, there is a tend- ' 
ency to inflammatory metamorphosis. 

Brain and Spinal Cord, — Congestion of the brain, 
with oversensitiveness to light ; heat and redness of 
the face, or pale face; carotids pulsate strongly; 
pulse full and strong (also Belladonna, Gelsemium, 
Veratrum Yiride); headache as if the brain were 


moved or raised; burning in the forehead as if in 
boiling water; vertigo; conjunctivitis; pupils con- 
tracted or dilated; formication over the spine; numb- 
ness of spine ; spasms from inflammation of spine ; 
numbness and tingling of limbs ; paralysis of limbs ; 
jerkings of arm and leg; nausea and vomiting of 
cerebral origin ; the least noise, especially of music, 
aggravates the brain symptoms. 

Mind. — Great fear of approaching death; incon- 
solable anguish ; dread of men ; fear of ghosts ; fears 
the loss of reason ; mental prostration, with weak- 
ness of memory ; cannot remember dates ; changing 
mood, from dry anguish to exuberant tears; the 
mind suffers from the effects of anger or fright. 

Sleep. — Sleeplessness, with anxiety and mental rest- 

Accompaniments. — Full hard pulse aiid flushed 
face ; hypertrophy of the heart ; pain in the cardiac 
region ; and pain and tingling in the left arm. 

Special Sphere of Action. — Aconite is indicated for 
the restless mental anxiety in the victims of intense 
shock. The state calling for Aconite is one of an- 
guish, anxiety, and nervous excitement. It has a 
marked influence upon the cerebral circulation, and 
is useful for cases in which formerly venesection was 
prescribed. In threatened apoplexy and apoplecti- 
form seizures, when there are congestion of the brain, 
vertigo, flushed face and thick speech, and when there 
are intense anxiety and restlessness. Aconite will 
often dispel or relieve these morbid symptoms, and 
sometimes apparently avert an attack. Experience 
in repeated cases has verified its usefulness under 
these conditions. In mania and melancholia, with 
intense restlessness, due to mental anxiety and nerv- 
ous excitement, with great fear of death, whether 

M I 


the condition is accompanied by fever or not, par- 
ticularly in acute cases with marked sthenic symp- 
toms, beginning with great violence, and when 
symptoms are worse at evening, a few doses of 
Aconite, given at short intervals during the early 
part of the night, will often procure for the patient a 
natural and restful sleep. 

Aconite is of great service in the convulsions of 
paresis ; also in those rapidly occurring convulsions 
of epilepsy which constitute the status epilepticus. 
Here Aconite seems to afford the relief which is said 
to follow the removal of the cerebrospinal fluid by 
lumbar puncture. 

Almost daily, by the use of this drug, we are able 
to check beginning inflammatory conditions caused 
by exposure to unusually cold draughts, and the 
early use of this drug in such cases is doubtless one 
reason why, at this hospital, there has been so little 
pneumonia in the past twenty-five years. 


General Action, — This fungus is classed by toxi- 
cologists as a narcotic, acrid poison (Christison). It 
acts upon the blood, rendering it fluid, so that it 
runs easily from the bodies of those killed by it ; it 
produces gangrene in the stomach and intestines. 

Brain and Spinal Cord. — Agaricus produces con- 
gestion of the brain, with stupidity; heaviness of the 
head as if intoxicated ; the spine is sensitive to touch ; 
there are severe burning pains in the spine, with jerk- 
ings or tremblings of the facial and cervical muscles. 

Mine/.— Confusion of mind; unable to find the 
right word when speaking (compare Alumina, Cal- 
carea Carbonica, Chamomllia., and Lycopodium); 


disinclined to answer questions ; sings and talks, but 
will not answer when spoken to ; indisposed to per- 
form any labor, especially mental; ill-humored and 
irritable ; merry and singing in ecstacies ; and again 
prostrated by general malaise ; people who are so-, 
licitous and anxious about ordinary afFairs become, 
under the effects of Agaricus, moody and indifferent 
to their surroundings. 

Sleep. — Irresistible drowsiness in the da3rtime ; on 
falling asleep the muscles of the body twitch sud- 
denly, and the patient awakens. 

Accompaniments, — Severe pains in the stomach; 
grass-green diarrheic stools; cutting pains in the 
abdomen, and sometimes dysenteric discharges. 

Special Sphere of Action. — Paretic conditions after 
sexual and other debauches ; mental obtuseness, with 
ill-humor; trembUng and twitching of groups of 
muscles; coma following febrile or mental excite- 
ment ; general paresis, mania and primary dementia. 


General Action. — The most characteristic effects of 
this substance are evidenced in motor weakness and 
sensory disturbance of the lower extremities, and in 
extreme dr3mess and irritation of the mucous mem- 
branes. The secretions are thick, scanty, and acrid. 

Brain and Spinal Cord. — Stitching burning pain 
in the head, with vertigo, worse in the morning, but 
relieved by food. Burning pain in the spine, as 
though pierced by a hot iron ; numbness of the legs, 
as though walking on cushions. Arms and legs 
heavy, as though paralyzed; legs weak and easily 
tired ; cannot walk without the aid of vision. 

Mind. — ^Low-spirited and hypochondriacal; little 
obstacles seem insurmountable ; is peevish, whining, 


and always ready to give up. Thoughts of suicide 
are suggested by the sight of possible means of its 
accomplishment, but are repugnant, and contribute 
to the patient's suffering. Time seems long; joy in 
work is gone ; the consciousness of personality is ob- 
scured ; memory fails ; and complete loss of reason is 
dreaded. These symptoms grow better as the day 

Sleep. — Lassitude during the day, with an inclina- 
tion to lie down. At night is restless, and disturbed 
by anxious dreams; awakens with palpitation of 
the heart. 

Accompaniments. — Dyspepsia, with capricious ap- 
petite; rejects nourishing food, and wants unusual 
and indigestible articles. Constipation, dry stools 
passed by great straining. Atrophic catarrhs of the 
upper respiratory passages, with scant, thick, tough, 
yellow mucus; ropy tenacious leucorrhea; conjunc- 
tivitis, the lids are cracked and stiflf. 

Special Sphere of Action. — Alumina is most usefiil 
in persons of advanced years, spare and wrinkled, 
and illy nourished. It is indicated in the milder types 
of melancholia, accompanied by considerable con- 
fusion of mind, and a tendency to chronicity. It has 
an extensive use in the spinal degenerations and 
paralysis of the lower limbs, particularly in loco- 
motor ataxia. 



General Action. — Anacardium depresses the intel- 
lectual centers and the organs of special sense, with 
sensations of general weakness and faintness. 

Brain and Spinal Cord. — Severe, tearing, nervous 
headache, or as though a plug were forced into the 
brain, usually on the left side. 


Mind. — Great weakness or total loss of memory. 
Recollection of single names presents the greatest 
difficulty. Irritable and passionate; irresistible de- 
sire to curse and swear. It sometimes seems to the 
distracted patient as though he had two separate 
wills swaying him in opposite directions; cannot 
apply the mind; hallucinations; seems to hear the 
voices of absent relatives, or to smell filth ever be- 
fore the nose, especially when smelling the clothes or 

Sleep. — Great sleepiness during the day ; mostly in 
the forenoon. 

Accompaniments. — Pain as if a plug were forced 
into various parts of the body, especially in the 
rectum, with constipation. Frequently hungry ; feels 
better while eating, but aggravated afterward. 

Special Sphere of Action. — Anacardium relieves 
nervous headache, the result of overexertion, and the 
weakness of memory and inability to think which 
result from exhausting physical disease, or which im- 
mediately follow the more violent symptoms of the 
acute psychoses; and it is sometimes used, though 
with much less success, because of the organic nature 
of the disease, in the various forms of terminal de- 


General Action. — The antimonial salts attack the 
mucous membranes, especially the lining of the 
gastro-intestinal canal, producing vomiting, and in 
poisonous doses purging, with profound depression 
of the vital powers. 

Brain and Spinal Cord. — Heaviness in the head, 
with vertigo. Headache increased by going up stairs. 
(Also Calcarea Carbonica). 


Mind, — Cross and peevish ; if only looked at is 
anery; sulky, and wants no communication with 
anfone ; sentimental ; has amorous longings, not for 
any living creature, but for some unseen seraph 
boded forth by an ecstatic imagination. 

Sleep. — Sleepiness during the forenoon; sleeps 
heavily, but is unrefreshed. 

Accompaniments. — Thickening and irregular 
growth of the skin and nails. The tongue is covered 
with a uniform white coating. Watery diarrhea, 
especially in hot weather, containing little lumps of 
fecal matter, with vomiting of food, and anorexia. 

Special Sphere of Action. — It is suited to the 
mental condition of some young persons passing 
through the critical pubescent period, whose grow- 
ing interest in the opposite sex tends to center un- 
healthfuUy in some bright Prince Charming, or in 
some idealized, and perhaps entirely self-created 
maiden. Moderate, regular occupation; plenty of 
exercise in the open air; frequent association with 
other boys and girls of a similar age under simple 
natural conditions, and attention to the character of 
the literature read, are cardinal accessories in the 
management of such a case. 


General Action. — Similar to Antimonium Crudum, 
with more nausea and retching, and greater circula- 
tory depression. The heart's action is feeble; the 
pulse soft and tremulous. 

Brain and Spinal Cord. — Its characteristic eflfects 
on the lungs, heart, liver, and stomach are brought 
about by its action upon the origin of the pneumo- 
gastric nerve. There is headache as if a band were 
compressing the forehead. (Mercurius, Nitric Acid, 


and Sulphur have the sensation of a hoop bound 
tightly around the head). 

Mind, — Restless and apprehensive ; does not want 
to be left alone, yet cannot bear to be touched. 

Sleep. — Yawning; irresistible desire to sleep; 
awakened often by abdominal disturbance. 

Accompaniments. — Inflammation of the smaller 
bronchi, much rattling of mucus in the chest; numer- 
ous fine bubbling rMes; oppression of breathing; 
blueness of the surface and cardiac failure; green 
watery diarrhea (Veratrum Album). A pustular 
eruption on the skin. 

Special Sphere of Action. — Antimonium Tartari- 
cum is a remedy little called for in treating the 
strictly mental manifestations of the insane, but of 
frequent use in combating their physical ills. In 
capillary bronchitis it should be given early, not, as 
often the case, administered only afber the rattling of 
death is heard in the throat, and no remedy can suc- 
ceed. It is also of use in the gastric and intestinal 
disorders which may follow when patients with im- 
paired judgment overload the stomach, as they will 
so frequently do if not watchfully guarded by an 
intelligent and observing nurse. 


General Action. — It defibrinates the blood, and 
causes inflammation of a low grade, in which the 
tissues rapidly break down and become gangrenous ; 
it also causes serous effusions. These blood changes 
produce mental stupidity, and often coma. 

Brain and Spinal Cord. — Hydrocephalus, with 
piercing shrieks; vertigo, worse lying down (also 
Conium); coma, with constant jerkings of the limbs ; 
stinging pains in the back. 


Mind, — Stupidity, absent-mindedness, awkward- 
ness; lets things drop from the hands (also Helle- 
bore); loss of memory; moody; irritable; jealous 
(also Hyoscyamus); mania from sexual excitement 
in women ; fear of death, with sensations that they 
are going to die. 

Sleep. — Great inclination to sleep, but cannot do 
so because of mental restlessness (Aconite and Cof- 
fea); cramping and starting in sleep; unpleasant 
dreams; dreams of flying and journeying. 

Accompaniments, — Erysipelatous condition of the 
face ; pain, and tenderness, and dropsy of the ovaries, 
especially the right; scanty micturition, and some- 
times a general dropsical condition. 

Special Sphere of Action, — Mental stupidity, with 
occasional periods of restlessness and screaming; 
jealousy in women who suffer with sharp pains in 
the ovaries, especially in the right. 


General Action, — It leads to destruction of the 
coloring matter of the red corpuscles; profound 
anemia and malnutrition, followed by destructive 
inflammations of the bones and periosteum; cerebro- 
spinal disturbances, and fatty degeneration of the 
muscles and glandular organs. 

Brain and Spinal Cord. — Tetanic convulsions, pa- 
ralysis, coma, and death from asphyxia follow the 
administration of large doses. Headache deep in 
the brain, or as if the cranial bones were expanding. 
(Also Glonoin). Better with tight band around the 
head (also Silicea). Spinal pains and weakness; 
limbs are weak and imperfectly co-ordinated, with 
vertigo, and trembling from nervous weakness. 


Mind. — Irresolute and melancholic; hesitates to 
undertake anything from fear of failure (also Arnica). 
Feels as if under a mental cloud (compare Cimi- 
cifiiga) ; and has no interest in ordinary employ- 
ments. The memory is poor. 

Sleep. — Restless; anxious, fnghtful dreams which 
seem true on awakening. 

Accompaniments. — Pain in the pit of the stomach, 
which radiates in all directions; belching of large 
quantities of wind; facial neuralgia, with a sour 
taste in the mouth ; asthma ; spasms of the respira- 
tory muscles; throat sore, dark red, and swollen; 
purulent ophthalmia. 

Special Sphere of Action. — It is useful in cases of 
hypochondriasis and mental failure, accompanied by 
flatulent or nervous dyspepsia, or caused by over- 
indulgence in the use of alcohol, and excesses in 
venery. It is indicated and successfully used in loco- 
motor ataxia, and to a less extent in other forms of 
sclerosis of the brain and spinal cord. Epileptic con- 
vulsions followed by tremor have also been cured by 
its administration. 


General Action. — It slows up the action of the 
heart, and raises the arterial pressure. There is capil- 
lary stasis, and a tendency to hemorrhages in the 

Brain and Spinal Cord. — Left-sided paralysis from 
concussion; tired, weary feeling in the head, worse 
on lying down ; sensation that everything feels hard. 

Mind. — The Arnica patient has fits of anguish or 
hopeless indifference ; forgets what he is reading, or 
the word he is about to use (Anacardium, Lilium 
Tigrinum, Lycopodium;; fears being struck by per- 


sons coming near him ; easily frightened ; unexpected 
troubles make him start; answers questions very 
slowly, sometimes falling asleep while answering. 

Accompaniments. — Bladder affections of trau- 
matic origin ; tenesmus, with spasms of the neck of 
the bladder; general prostration from blows upon 
any part of the body. 

Special Sphere of Action, — Arnica is useful in cases 
resulting from traumatism, particularly when men- 
tal disturbance is traceable to injury about the head, 
even though the injury occurred several years pre- 
viously. Schroeder Van der Kolk claims that Arnica 
is invaluable in certain cases of mania when the first 
excitement has passed, and there remain a heat in 
the head, and a tendency to imbecility. Arnica is 
also of use after apoplectiform seizures and paralytic 
symptoms which remain after apoplexy. The pa- 
tient manifests weakness of memory, and confusion 
of mind ; is absent-minded, complains of a bruised, 
sore feeling, especially after concussion. This sensa- 
tion of soreness, as though from a bruise, is charac- 
teristic of Arnica. 


General Action. — ^Arsenicum acts upon the gang- 
lionic nervous system ; it acts upon the mucous and 
serous membranes, producing in the former espe- 
cially, inflammation of a low grade. There is a 
marked tendency, under Arsenicum, of the tissues to 
become gangrenous; also there are efiusions into 
those cavities which are lined by serous membranes. 

Brain and Spinal Cord.— The nervous system is 
apparently affected, reflexly, by the disturbance of 
the digestive apparatus; there is frontal headache, 
and the pains are of a burning character ; there are 


vertigo and tinnitus aurium; sensitiveness and burn- 
ing in spine. 

Mind, — Melancholia; and tearful and depressed 
mood ; intense anxiety, with great restlessness ; fears 
to be left alone lest he should do himself bodily 
harm ; great fear, with cold sweats ; cannot find rest 
anywhere; w^ants to move from bed to bed; is in- 
tensely suicidal, and is inclined to mutilate the body ; 
the patient has hallucinations of smell ; smells pitch 
and sulphur, and anticipates consignment to sheol. 

Sleep. — Sleeplessness, with restlessness and anx- 
iety; frequent starting in sleep; awakened by pain, 
especially after midnight; after sleep feels as if he 
had not slept enough; dreams full of care, sorrow 
and fear, about thunderstorms, fire, black water, and 

Accompaniments. — Asthmatic conditions ; diffi- 
ctdty in respiration; thirst for small quantities of 
water at frequent intervals ; weakness and palpita- 
tion of the heart ; emaciation of the body, followed 
by dropsical tendencies ; scanty urine, and burning 
during micturition. 

Special Sphere of Action. — Arsenicum finds a va- 
riety of application among the insane in aflfections 
characterized by periodicity, great weakness and 
prostration, symptoms of a malign nature, restless- 
ness and anguish, burning sensations, unquenchable 
thirst for small quantities of water, and, very often, 
pains which are worse at rest, and increased by cold. 
It is usefiil when the patient is delirious, depressed, 
restless, has fear of death, fear of being alone, and has 
strong suicidal tendencies. There is often noticed a 
tendency among the insane to mutilation of the 
body ; picking the skin until it is sore, and chewing 
the finger nails. Here Arsenicum relieves. This drug 


causes intense prostration ; hence it is usefal in those 
cases of acute delirious mania and exhaustive insani- 
ty which are accompanied by typhoid symptoms and 
by rapid emaciation. We note especially its good 
eflFects upon the victims of resistive and restless 
melancholia, of active and ever-stirring mania, and 
of rapidly failing paresis. Dr. Hughes states that Ar- 
senicum is one of the few remedies which causes gen- 
uine neuralgia, and far excels all other remedies in 
the treatment of idiopathic disorder. There is intense 
sensitiveness of the scalp under Arsenicum. This 
drug is said to produce epilepsy, with opisthotonos ; 
and is a valuable remedy in the treatment of epilepsy 
when the paroxysms recur periodically. In sleepless- 
iless it is pre-eminently an effective remedy for those 
who are suffering from malnutrition, from emacia- 
tion, and from blood degeneration, accompanied by 
extreme exhaustion of the nervous system. Not only 
is the brain anemic, but the entire body likewise. 
By keeping a weak and exhausted patient in a prone 
position both day and night ; by the liberal use of a 
hot liquid diet ; and by the administration of Arseni- 
cum as a restorative medicine, a subtle and charm- 
ing effiect is speedily produced, as is evidenced by 
pleasant and abundant sleep at night, and the rapid 
regaining of health and spirits during the daytime. 


General Action. — Aurum affects the connective 
tissues, producing degenerations of the bones, gland- 
ular organs, and mucous membranes, similar to 
those found in syphilitic, mercurial, or scrofulous 
disease. Hyperemia accompanies all other symp- 
toms as a pathological characteristic. 


Brain and Spinal Cord, — Tearing headache deep 
in forehead, with congestion of the brain, and worse 
from mental work. 

Mind, — Has no confidence in himself, and thinks 
others have none ; has a feeling of self-condemnation 
and worthlessness. Great mental anguish; tired of 
life, and cannot keep the mind from thoughts of 
suicide. The melancholia may be of a religious form, 
when constant prayer may be the most noticeable 
symptom. The memory is weak, and mental labor 
is difficult. 

Sleep. — Sobs during sleep, or screams aloud from 
frightful dreams; wakeful during the night, but 
without lassitude in the morning. 

Accompaniments, — Fetid nasal discharge; caries 
of the bones, especially about the nose and palate ; 
rhinitis ; sees things double ; boring pain behind the 
ear ; oflFensive otorrhea ; inflammation and degenera- 
tion of the liver and kidneys; chronic orchitis, and 
uterine prolapsus from congestion. 

Special Sphere of Action, — Aurum has been con- 
sidered the remedy in melancholia, and particularly 
if due to syphilitic disease, or to the abuse of the 
mercurials; but in our experience it has frequently 
failed to accomplish the desired results. 


General Action, — It disorganizes the blood, and 
produces putrid conditions in all parts of the body, 
with great prostration and exhaustion. 

Brain and Spinal Cord, — Cerebral congestion; 
face has a besotted appearance ; dull, heavy pain at 
the base of the brain ; paralysis of the left side, with 


Mind. — Confused as if drunk ; feels as if he were 
sliding away; bed feels too hard (also Arnica); 
thinks his body is scattered about, and struggles 
constantly to get himself together ; restless, but too 
lifeless to indulge in active exertion ; can be roused, 
but before answering a question, falls asleep again. 

Sleep. — Sleeps well till three a. m. (also Nux 
Vomica); is then restless till morning; cannot sleep 
because he thinks his head and body are scattered 
about ; restless, with frightful dreams ; mutters in a 
delirious way even while partially asleep. 

Accompaniments. — Intensely fetid breath; dry, 
hot mouth ; tongue very dry and brown, and marked 
sordes on the teeth ; involuntary stools of a strongly 
oflFensive nature ; the diarrhea is brownish in color, 
and often looks like decomposed blood. 

Special Sphere of Action. — Baptisia may be used 
in mania and melancholia when there are stupor, 
rapid and profound degeneration simulating the 
typhoid state, and when the patient manifests the 
peculiar mental symptom that he ** cannot get him- 
self together.'* It is a singular fact that many in- 
sane patients have the delusion that their bodies arc 
scattered, and they cannot keep themselves in a state 
of bodily contiguity. 


General Action. — Belladonna acts upon the cere- 
bro spinal system, causing intense cerebral hyper- 
emia. There is a bright red face, dilated pupils, 
intolerance of light, and violent spasms of the mus- 
cles of the face, neck and arms. 

Brain and Spinal Cord. — Severe headache, espe- 
cially in the frontal region; the headache is of a 
throbbing nature (also Glonoin and Cactus); the 


pains come suddenly, and as suddenly depart; full- 
ness of the head, with throbbing arteries; boring, 
shooting pains in the head, all aggravated by noise. 

Mind. — Belladonna develops two distinct states 
of mind. One where the patient is flushed; the 
mental powers seem unduly excited and exaggerated. 
Hallucinations and illusions of sight are present ; he 
sees giant forms; these sometimes excite fear and 
laughter; a maniacal state in which the patient is 
merry (also Hyoscyamus); most characteristic there 
are fiirious delusions and rage; the patient tears 
clothing, bites, strikes, kicks, howls, shrieks, and 
wants to get away. There is a contrary state where 
the patient passes into a stupid and dazed condi- 
tion; the pupils remain widely dilated; the eyes 
are staring and insensible to -light ; there is heavy 
stertorous breathing; the face is purplish red; the 
patient refuses to speak; there is marked rigidity 
or steady tension of the muscles; and occasionally 
there is low muttering delirium. 

Sleep, — Sleepy, yet cannot sleep (also Gelsemium); 
jerking of the limbs in sleep; dreams of murder, of 
robbery, and of danger from fire ; sleeplessness from 
excessive cerebral hyperemia. 

Accompaniments, — Spasmodic condition of all 
the sphincter muscles ; paralysis of the left side, with 
twitching of the muscles of the right side ; bright red 
condition of the skin; active inflammatory condition 
in the throat, chest, kidneys, bladder, and genital 

Special Sphere of Action. — It is particularly use- 
ful in conditions of mental excitement in any form 
of insanity. It is indicated in full-blooded people, 
with a tendency to cerebral hjrperemia, in threat- 
ened apoplexy, and in insanity following acute 


diseases. In his mania the patient is likely to be 
wild, fierce, trying to escape, or to injure those who 
are in attendance upon him. He manifests a pugna- 
cious disposition which renders him an unpleasant 
person to care for. His eyes are bright, the con- 
junctivae are congested, the pupils are dilated, and 
the mucous membranes are dry, particularly about 
the throat. The skin is hot; the face is flushed. 
Later the patient .may become dull and stupid, dis- 
inclined to answer questions, and unwilling to be 
disturbed. Belladonna is also useful in the beginning 
of meningitis, having an active influence in control- 
ling cerebral hyperemia, and subduing with remark- 
able efficacy the processes of inflammation. 


General Action. — Serous membranes are especially 
afiected by Bryonia. This drug seems to have 
marked affinity for the pleural coverings of the 
lungs, and for the peritoneal linings of the abdomen. 
Again, it affects the joints, producing rheumatic 
pains ; and it likewise pays its respects to the brain 
and its membranes, producing symptoms of active 
and intense congestion. 

Brain and Spinal Cord. — Head feels confiised and 
foil as after a night's dissipation; there is frontal 
headache extending backward to the occiput (Bella- 
donna, Spigelia, and Gelsemium have headache run- 
ning from the occiput to the forehead); headache as 
if the head would burst ; this pain grows worse dur- 
ing the day, and is aggravated by motion ; head feels 
too foil, and there is much vertigo. 

Mind. — Depression and moroseness without cause; 
the patient is irritable and wishes to be alone (also 
Coca) ; is obstinate and passionate, and is troubled 


with what has been called "pure cussedness" (also 
Nux Vomica); the patient worries much about busi- 
ness affairs. 

Sleep, — Sleep is very restless; during sleep is 
troubled with somnambulism; sleeplessness from 
thoughts crowding upon each other ; dreams about 
the business of the day. 

Accompaniments. — Cough, usually dry, but some- 
times there is sputum which is streaked with blood ; 
cannot take a deep breath; stitching pains in his 
side, aggravated by motion; sensation as if the head 
and chest would fall to pieces on coughing ; intense 
thirst for large quantities of water. 

Special Sphere of Action. — Characteristics which 
call for Bryonia are : An apathetic mental condition, 
ranging from languor to torpor, aggravated by 
motion of the head. The patient is disposed to be 
irritable when disturbed or aroused, and the remedy 
is useful for the bad effects following the manifesta- 
tions of violence and anger. It is not a remedy on 
which we rely greatly in the cure of mental disease, 
yet it often relieves attacks of acute physical disease. 
It has been of especial service in epidemics of influ- 
enza or la grippe ; in congestions following exposure 
to cold, and when there has been a tendency to dis- 
eased conditions of the serous membranes. It is a 
usefikl remedy in constipation occurring among the 
insane when the stools are large, dark and dry as if 
burned, and expelled with great difficulty. 


General Action. — ^This drug appears to have a 

special affinity for the heart and its nerves, causing 

more or less irregular action; constricting pain 

about the heart, with anguish. 


Brain and Spinal Cord, — Throbbing pains in the 
vertex of the head, and along the spine. 

Mind. — Melancholia ; unconquerable sadness ; fear 
of death (also Aconite) ; believes his disease incur- 
able (also Ignatia, Lilium Tigrinum, Natrum Muri- 
aticum, and Sepia). 

Sleep. — Sleeplessness, with pulsations at the pit of 
the stomach ; palpitation of the heart, and a sensa- 
tion of palpitation in the top of the head ; delirium 
at night and during sleep, which ceases on awaken- 
ing. (Also Gelsemium). 

Accompaniments. — Sensation as if an iron band 
were about the heart, preventing its normal move- 
ments ; pain in the apex of the heart, shooting down 
to the fingers of the left hand ; irregularity of the 
heart's action, now rapid and again slow^; slow 
pulse (also Digitalis). 

Special Sphere of Action. — Melancholia, partic- 
ularly in women, with a sensation of constriction 
about the heart ; palpitation of the heart, and a cor- 
responding palpitation on the top of the head. 


General Action. — This drug seems to have a 
special affinity for the lymphatic system; its phy- 
siological action is not thoroughly understood, but 
provings and clinical experiences point to the glands 
of the body as the organs primarily affected. 

Brain and Spinal Cord. — It produces a brain fag, 
frontal headache, with heaviness of the head, worse 
from reading or writing; it produces chorea, with 
one-sided movement ; and it produces epilepsy, with 
aura running downward. 

Mind. — Forgetfulness ; probably one of the most 
effective remedies for this difficulty ; the patient mis- 


places words (compare Agaricus and Arnica) ; fears 
she will lose her reason ; that misfortune is impend- 
ing ; that people will observe her confusion of mind ; 
peevishness ; anxiety and shrinking on the approach 
of evening; much mental trouble about imaginary- 

Sleep. — Awakes too early, three a. m.; sleepiness 
during the daytime ; dreams of falling. 

Accompaniments, — The menses appear a few days 
before the proper time, and the flow of blood is often 
considerable; sensation as if feet and legs were in- 
cased in damp stockings ; the patient is pale, weak, 
poorly nourished, and imperfectly developed. 

Special Sphere of Action, — The various salts of 
lime are useful in combating unfortunate constitu- 
tional tendencies which are present in the human 
race, whether sane or insane. Cases of defective 
growlh, either physical or mental, are often im- 
proved by the use of Calcarea. It is useful when 
there is defective bony development, and also when 
there is emaciation due to constitutional causes. In 
glandular troubles with lymphatic swellings, it is 
efiicacious in affording relief. The Calcarea patient 
is of light complexion, of scrofulous appearance, in- 
clined to lay on flabby fat, has a large abdomen, a 
bulging forehead, and a small neck ; the patient is 
disposed to sweat a good deal about the head, and is 
troubled with cold feet. Calcarea patients are apt 
to be apprehensive at times, and to fear that they 
will go ** crazy ;" but generally a sluggish and apa- 
thetic mental state is present. It is especially 
adapted to cases of mild but sluggish melancholia in 
fat, flabby, non-energetic and pot-bellied persons. 



General Action. — Similar to the carbonate of lime. 

Brain and Spinal Cord, — Cerebral anemia; ver- 
tigo, \vorse on rising ; trembling of the limbs. 

Mind. — Forgetfiilness of what has been done a 
few moments before; writes wrong words, and the 
same word twice or more times; wishes to be at 
home although he is at home ; general failure of the 
mental powers. 

Sleep. — Drowsiness all day, yawning and stretch- 
ing ; dreams of past experiences during the night. 

Accompaniments. — Pale and flabby conditions, 
with cold and blue extremities; imperfect circula- 
tion ; general sluggishness of all the bodily fimctions. 

Special Sphere of Action. — Dementia, especially of 
young persons and those addicted to masturbation, 
or those who have exhausted themselves from mas- 
turbation ; senile dementia, loss of memory from old 
age, or from cerebral disease. 


General Action. — It acts upon the cerebrospinal 
system, depressing the motor and intellectual centers. 

Brain and Spinal Cord. — It produces vertigo and 
heaviness of the head, constriction of the brain, with 
throbbing in the cerebrum. Mentally, there is anx- 
iety and extreme restlessness, and a sense of intoler- 
able prostration; from this prostration the mind 
sometimes rises to great maniacal excitement, some- 
what similar to that produced by Veratrum Album. 

Accompaniments. — Icy coldness of the whole 
body ; clammy and exhausting sweats ; cramps, par- 


ticularly of the lower limbs ; all symptoms are ag- 
gravated at night, from motion and from cold. 

Special Sphere of Action. — Exhaustion and col- 
lapse from mania, from epilepsy, or from melancholia 
with excitement. 


General Action, — It acts upon the cerebrospinal 
system, producing various eflFects; sometimes it 
causes a mild exhilaration, and again it stimulates 
the prover to intense and exalted ecstacy; it pro- 
duces decicjed eflFects upon the psychical system, and 
stirs the mind to a wonderfiil variety of action. In 
this respect it somewhat resembles Opium, Agaricus, 
Belladonna, and Alcohol. 

Brain and SpinalCord, — Pleasurable intoxication, 
with bright, shining eyes ; heaviness of the arms and 
legs, making it difficult to move or exercise ; a sensa- 
tion as if the head were opening and shutting along 
the vertex. 

Mind. — Numerous hallucinations and illusions ; 
sensations and motions are greatly exaggerated; 
time and space seem immeasurable; a few seconds 
seem to be ages or cycles of time ; a few rods seem an 
immense distance ; the patient is unable to recall any 
thought or event of the past on account of the multi- 
tude of images which at present crowd upon the 
brain; great mental exaltation, with singing and 
laughing ; but this exaltation is followed by sadness, 
depression and weakness; the natural tendency of 
the individual is exaggerated under the influence of 
Cannabis Indica; the mild and gentle person be- 
comes more pleasant, happy and agreeable than 
common, while those possessing irritable disposi- 


tions become exceedingly vicious and violent under 
this drug. 

Sleep. — Excessive sleepiness; voluptuous dreams 
in which are realized the prophesies and promises of 
Mahomet's heaven for the time being; but morning 
discovers to the tired dreamer only profuse seminal 
emission. Dreams of anger, of dead bodies, and of 
horrible objects ; intense nightmare. 

Accompaniments. — Frequent micturition, with 
much burning in the urethra; urine starts slowly 
and dribbles in a feeble stream ; sexual desires greatly 
increased ; violent erections when walking, or riding, 
or sitting still, and without amorous thoughts, ex- 
cept during the dreams. 

Special Sphere of Action. — Nervous diseases, with 
delusions relating to time and space, accompanied 
by unusual sexual disturbances, followed by weak- 
ness of mind, tremulousness and exhaustion of body. 
It may be useful in relieving the symptoms of general 
paresis and catalepsy. The cataleptic state may 
sometimes be induced by an overpowering belief in 
the patient's mind that time and space are too vast 
for change, hence a disinclination to make eflFort. 


General Action. — This drug acts upon the cerebro- 
spinal system, and it affects the genito-urinary tract 
most positively. 

Brain and Spinal Cord. — Cerebral congestions; 
convulsions resembling hydrophobia, which are pro- 
duced or aggravated by the sight or sound of water. 
Hughes denies this symptom, but we have observed 
some Cantharis cases that were much disturbed by 
seeing water, or any bright, glistening substance. 
(Also Stramonium). 


Mind. — Sudden loss of memory ; furious delirium ; 
barking like a dog; paroxysms of rage excited by 
any bright, dazzling object ; amorous frenzy ; intoler- 
able sexual desire ; mania, ivith a tendency to s^wear 
(also Anacardium); violent, contradictory moods; 
restlessness, culminating in attacks of rage; great 
activity and sensitiveness of the mind. 

Sleep, — Sleeplessness ; light sleep with anxious 
dreams; erections during sleep (also Cannabis In- 
dica), followed by wakefulness and anxiety. 

Accompaniments. — Intense burning and smarting 
pains along the urethra; spasmodic pains in the 
region of the bladder; paroxysmal pains in both 
kidneys ; the back in the region of the kidneys is sen- 
sitive to touch ; constant urging to urinate ; painful 
evacuation, drop by drop, of bloody urine, or pure 
blood; sharp, burning pains in the genital organs, 
accompanied by erections and fierce desire for sexual 

Special Sphere of Action. — Cantharis is usefid 
among the insane when the female patient suffers 
with an intense nymphomania, or the male is af- 
flicted with satyriasis. There is usually an inflam- 
matory condition in some portion of the genito-urin- 
ary tract which so excites the sexual desire that the 
patient loses entirely his self-control, and resorts to 
the most debasing practices, in order to gratify his 
insane sexual impulses. The patient has at times a 
furious delirium, during which he will cry, or bark 
like a dog, and at times he will manifest great excite- 
ment at the sight of water. This latter symptom is 
suggestive of the conditions present in hydrophobia. 
(Picric Acid is similar in its action to Cantharis, and 
in large doses it produces an almost uncontrollable 
sexual excitement. It is a valuable remedy when 


sexual excesses have produced exhaustion of the 
vital forces and a condition of neurasthenia prevails. 
It is also usefal in melancholia with indiflference^ 
want of will power, and abject despair. Even in 
acute dementia with utter exhaustion it is a rival of 
Phosphoric Acid. There is burning along the spine, 
weakness of the legs and back, severe pains in the 
back and occiput, going up to the supraorbital 
notch. The least exertion causes prostration. In 
such cases it has proved of striking benefit among 
the insane). 


General Action. — Causticum depresses the ftmc- 
tion of the motor nerves, especially those which take 
their origin from neuclei in the medulla oblongata. 

Brain and Spinal Cord, — Vertigo, with a tendency 
to fall either forward or to the side ; brought on by 
motion, or looking steadily at any object. Paralysis 
of the recti muscles, or of the muscles of the face, 
tongue, throat, or, more rarely, of the bladder and 

Mind, — ^Timid, uneasy, fretful ; disinclined to work,, 
and cannot fix the attention upon any task; the 
patient is sallow and sickly in appearance ; is appre- 
hensive and despondent ; distrustful, and as is often 
the case with an invalid, self-control is partially lost, 
and he is inclined to break into peevish periods of 
impotent anger. 

Sleep, — Restless; the limbs twitch and jerk, but 
writhout interrupting sleep. 

Accompaniments, — Weakness of the vocal cords, 
with catarrhal inflammation of the larynx ; hoarse- 
ness worse in the morning ; painfiil cough with diffi- 
cult expectoration of soapy tasting mucus ; stiffiiess 


of the joints; contraction of the adjacent tendons 
brought on and aggravated by exposure to cold. 

Special Sphere of Action, — Causticum is especially 
indicated in partial paralysis of the muscles supplied 
by a single nerve, though it is sometimes prescribed 
with benefit for the paralysis following cerebral 
apoplexy; in either case accompanied by irritable 
mental weakness and indecision. It is a remedy for 
the constitutionally timid, and for anemic persons of 
scrofalous habit. 


General Action. — It acts on the cerebrospinal ner- 
vous system, with characteristic affections of the 
emotional sphere. 

Brain and Spinal Cord. — Violent, constricting, 
pressing, boring headache ; pressure from the vertex 
extending over the forehead and temples ; congestion 
of the brain following fits of anger (also Bryonia) ; 
stiffness of the cervical muscles ; drawing pains in the 
scapulae; pain in the back extending through the 
abdomen to the front, and into the genitals ; severe 
pain in the loins and hip joints. 

Mind. — Irritable, impatient, peevish and snap- 
pish; extreme sensitiveness to external impressions 
(also Coffea, Ignatia, Belladonna and Staphisagria) ; 
imagines he hears voices of absent friends at night ; 
bad effects of anger; the patient is extremely cross 
and sensitive (Nux Vomica is cross, but not so sensi- 
tive as Chamomilla). 

Sleep. — Sleeplessness from pain, and from ill- 
temper; even while sleeping the patient moans, 
weeps, wails, and starts suddenly ; on falling asleep 
is tormented by anxious and frightfal dreams. 

Accompaniments. — Sharp toothache ; griping 


colic, Tvith flatulence ; severe pains across the abdo- 
men, followed by bilious diarrhea, and acrid dis- 
charges from the vagina. 

Special Sphere of Action. — Chamomilla is usefiil in 
conditions of excessive hyperesthesia, and this over- 
sensitiveness is accompanied by a corresponding 
mental state which has been well described as one of 
** snappish irritability." The patient is cross, im- 
patient, and irritable. Nothing suits him; he is 
angry, and cannot endure being spoken to, and will 
not reply respectfully or even decently to any one 
who addresses him. (Compare Antimonium Tar- 
trate). The patient cannot bear pain, and makes 
excessive complaint because of slight ailments. This 
remedy is frequently prescribed for these symptoms 
among the insane, and is of great service in aflfording 
relief to the oversensitive. It relieves the sleepless- 
ness of those who lie awake on account of severe pain, 
such as neuralgia aflfecting a single nerve, or a small 
group of nerves. Such patients are exceedingly cross 
and irritable, and indulge in frequent jerkings of the 
limbs, and twitchings of groups of muscles. It is a 
remedy that has acquired much fame on account of 
its success in relieving the sleeplessness of children, 
and of weak and nervous women. 


General Action. — China acts upon the ganglionic 
nervous system, and hence it aflfects especially the 
ftinctions of vegetative life. China changes both the 
quantity and the quality of the blood. Under its 
influence the blood becomes more fluid than normal ; 
the circulation becomes impaired, and we have gen- 
eral debility and erethism, followed by chills, fever, 
sweat, and finally hemorrhages. China produces 


congestion of the liver, obstructing the function of 
that organ; it produces excessive sensitiveness of the 
entire nervous system. 

Brain and Spinal Cord. — Intense congestion of the 
brain; intense throbbing headache ; vertigo; ringing 
in the ears ; deafness ; blindness. With the dizziness 
there is a feeling as if the head would burst. This 
feeling is worse from motion or sudden anger ; insup- 
portable pain in small of back, like a cramp, worse 
from least movement. 

Mind. — Chooses wrong words, and makes feeble 
and senseless expressions. The patient cherishes a 
fixed idea that he is unhappy, and that he is perse- 
cuted by his enemies ; feels impelled to jump out of 
bed ; wants to destroy himself, but lacks courage ; is 
low-spirited, gloomy, and has no desire to live; 
cherishes an uncontrollable anxiety ; and, above all, 
is stubborn and disobedient. Patients are sometimes 
sent to insane asylums because they have been made 
insane, in my opinion, not alone by the diseases from 
which they suflfered, but also by a blind, reckless and 
unwarrantable use of Cinchona, or its alkaloids, 
given in overpowering and disastrous doses. Cin- 
chona, if unwisely used, may become as dangerous 
in its effects as the excessive use of alcoholic stimu- 

Sleep. — Irresistible desire to sleep after eating; 
constant yet unrefireshing sleep ; or at times sleepless 
from ideas crowding too rapidly upon each other. 
(Also Apis and Coffea). The patient is bent upon 
making plans for the future, hence his sleep is short 
and unrefreshing. 

Accompaniments. — Loss of appetite; slow diges- 
tion ; thin, watery, involuntary diarrhea ; weakness 
and disability from long continued sickness, and 


from excessive losses of fluid from the body; fever 
recurring at somewhat regular intervals. 

Special Sphere of Action, — Melancholia and sub- 
acute mania when there are general anemia, pro- 
found debility, and tendency to periodical aggrava- 
tion of all the symptoms. 


General Action, — This drug is a cerebro spinal 
irritant, producing epileptiform convulsions, tetanus, 
and generally tonic and clonic spasms. 

Brain and Spinal Cord. — Severe occipital head- 
ache ; vertigo, with opisthotonos. 

Mind, — Dull and stupid, or the patient indulges in 
weeping and howling; sometimes great mental ex- 
citement exists, and the patient sings, shouts, and 

Accompaniments, — Grinding of teeth ; swelling of 
tongue; difficulty in speech; involuntary twitching 
of muscles in the arms and fingers (also Cuprum). 

Special Sphere of Action, — Mental depression and 
anxiety, accompanied by vertigo, after traumatism ; 
general paralysis, with spasmodic twitchings ; some- 
times loss of consciousness; mental anxiety, with 
violent hiccough. Cicuta is one of the most effective 
remedies for persistent hiccoughing known in the 
Materia Medica. 


General Action, — It produces cerebral and spinal 
hyperemia, with irregularity of motion, and great 
w^eakness and tremulousness of the extremities. 

Brain and Spinal Cord, — Headache throughout 
the whole brain, with sense of soreness in the occi- 


pital region ; vertigo ; brain feels too heavy and too 
large for the cranium ; the top of the head feels as if 
it would fly Q&. 

Mind. — Great melancholy, with sleeplessness, fol- 
lowed sometimes by transient exhilaration ; halluci- 
nations of sight, sees rats, sheep, etc.; sensation as 
if a heavy black cloud had settled over her, and en- 
veloped her head, so that all was darkness and con- 
fusion ; at the same time there seems to be a weight 
like lead upon the heart ; suspicious, indifferent ; taci- 
turn; takes no interest in household matters (also 

Sleep. — Sleeplessness from nervous irritation ; 
sleeplessness, with great depression and despair. 

Accompaniments. — ^There is a general rheumatic 
diathesis; severe cutting pains in the joints and in 
the back ; in women there is with the mental depres- 
sion a sense of weight and bearing down in the 
uterine region (also Belladonna), with a feeling of 
heaviness and torpor in the lower extremities; re- 
tarded menstruation ; suppression of menses from a 
cold, with rheumatic pains in the head, extending 
down to the neck and back; tremulousness of the 
muscles throughout the body. 

Special Sphere of Action. — Mental depression as- 
sociated with uterine diseases ; mental depresion ac- 
companied by rheumatic pains; mental depression 
and tremulousness, following overwork and active 
dissipation ; delirium tremens ; bad effects of opium. 
It is indicated in general paresis when the patient is 
weak and exceedingly tremulous throughout the 
whole body, and particularly in the melancholic 
stage of the disease. 



General Action. — On the motor traxit of the cere- 
brospinal axis, and especially on the cerebellum, pro- 
ducing fulness of the head, and a swaying of the 
body in a semicircular direction, with loss of power 
in the lower limbs. 

Brain and Spinal Cord. — Vertigo, with inclination 
to vomit ; sensation as if the head were swollen ; 
headache in the occiput and nape of neck ; sensation 
as if the back of head were opening and shutting like 
a door ; headache aggravated by riding in a wagon ; 
paralytic weakness of the back and legs, and a feel- 
ing as if the soles of the feet were asleep. 

Mind. — Vacillating ; cannot accomplish any 
work; slowness of apprehension; time passes too 
quickly (too slowly. Cannabis Indica); sobbing, 
moaning and groaning; thoughts continue upon 
some one unpleasant subject; depressed; easily of- 
fended; every trifle makes him angry; a delusion 
that his organs are hollow ; sometimes this delusion 
relates to the head, or the chest, or the abdomen. 

Sleep. — Sleeplessness from night-watching (Colchi- 
cum) ; sleep aggravates all the symptoms (Lachesis). 

Accompaniments. — Physical and mental sjrmp- 
toms aggravated by eating or drinking; intense 
nausea ; an inclination to vomit while riding in a 
carriage or a boat; great distension of the abdo- 
men, with colic; in a female, cramping pains in the 
uterus and ovaries, with nausea and headache ; vio- 
lent spasmodic pains during the menstrual flux, after 
mortification or disappointment. 

Special Sphere of Action.— Diseases accompanied 
by intense vertigo, relieved by lying down ; diseases 


caused by overexertion, overstudy, overdrinking, 
the motion of travel ; uterine disorders at the change 
of life; victims of masturbation; victims of excessive 
ambition who have been disappointed, snubbed, and 
angered by those around them. (For dissipation 
and disappointment we also think of Nux Vomica, of 
Gelsemium, and of Ignatia). 


General Action, — Acts upon the cerebrospinal 
system, causing an increased susceptibility to ex- 
ternal impressions — that is, a general hyperesthesia 
of the nervous system. 

Brain and Spinal Cord. — Headache from think- 
ing ; headache as if the head were torn or dashed to 
pieces; headache as if a nail were driven into the 
head (also Hepar Sulphur and Ignatia) ; a CoflFea 
headache, like Nux Vomica, is worse after eating. 

Mind, — Ecstasy ; fiiU of ideas ; quick to act ; great 
mental restlessness ; all the senses under Coffea are 
stirred to acute and rapid action ; under its primary 
and secondary influences the mind oscillates between 
the heights of ecstatic and sensitive joy, and the 
depths of gloomiest and most dismal despair. 

Sleep, — Sleeplessness because mind is very active 
(also China), and because the emotions have been 
driven by pleasant occurrences into a state of ex- 
cessive excitement. 

Accompaniments. — General acuteness of the sen- 
ses; distressing and insupportable pains, particu- 
lary neuralgia of the right side of the face and head ; 
an aversion to the open air because it seems to ag- 
gravate the pain. 

Special Sphere of Action, — Melancholia with ex- 
citement and sleeplessness ; hysterical aflfections pro- 
duced by excessive pleasurable emotions. 



General Action, — It acts upon the processes of 
nutrition; increases the secretions generally, and 
especially the quantity of urea and uric acid elimi- 
nated. In poisonous doses it is an irritant to the 
alimentary tract, and causes death by collapse and 
paralysis of respiration. 

Brain and Spinal Cord. — Boring headache over 
the eyes ; pressure, especially in the occiput ; para- 
lytic sensations and numbness of the hands and feet. 

Mind, — Sensitive to external impressions, espe- 
cially bright lights and strong odors; memory 
weak ; intellect clouded ; the patient is peevish, fret- 
fill, and never satisfied. 

Sleep. — Sleeplessness after night- watching or 
studying at night ; awakened fi-om sleep by dreadfiil 

Accompaniments, — Great thirst, but no appetite; 
aversion to food, and especially to the smell of food ; 
great distension of the abdomen, with colicky pains ; 
dark and scanty urine; rheumatism, accompanied 
by great exhaustion, and by weakness of both body 
and mind. The pains are all of a boring nature. 

Special Sphere of Action. — It acts well in patients 
who are depressed and irritable, and who are of a 
rheumatic or gouty diathesis. 


General Action. — This drug acts upon the gangli- 
onic nervous system, more particularly upon the 
solar plexus, the lumbar and the femoral nerves, and 
the tissues which these nerves supply. 

Brain and Spinal Cord. — Pressive frontal head- 


ax:lie, tearing and digging through the whole brain ; 
sharp, cutting pains along the tracts of the main 
nerves leading from the brain ; cramping pains in the 
lumbar region, extending down to the legs, espe- 
cially along the course of the sciatic nerve. 

Mind. — Extremely irritable and easily angered; 
impatient and morose. In mental irritability, Co- 
locynth imitates Chamomilla and Nux Vomica. 

Sleep. — Sleeplessness on account of acute cramp- 
ing pains ; inclined to sleep as soon as the pains pass 

Accompaniments. — Sharp, colicky pains in the ab- 
domen, doubling the victim up like a jack-knife; 
diarrhea watery, yellow, frothy, and accompanied 
by much flatulence. 

Special Sphere of Action. — Persons of nervo-bilious 
temperament, and those suffering from severe cramp- 
ing and neuralgic pains, and from the effects of 
sudden outbursts of anger (Bryonia). 


General Action. — Its effects are especially notice- 
able upon the motor nervous tract; it produces 
paralysis from the feet up. One of the best provings 
of hemlock may be found in the death of Socrates. 

Brain and Spinal Cord. — Intense vertigo, worse 
on lying down ; headache as if the head would burst ; 
pain in the occiput, and at each heart beat the brain 
at the base feels as if stabbed with a sharp knife; 
trembling of limbs; sensation of weakness in the 
back and limbs ; sense of exhaustion as if paralyzed. 

Mind. — ^Loss of memory; inability to make any 
mental effort. 

Sleep. — Unrefreshing, and disturbed by frightful 



Accompaniments. — Palpitation of the heart ; vio- 
lent, spasmodic, dry cough; sexual desire without 

Special Sphere of Action. — Senile dementia; mental 
weakness ; loss of memory ; peevishness ; vertigo. It 
is useful when persons suflfer from the ill eflFects of 
ungratified sexual desire ; it is therefore useful in re- 
lieving the ailments of old maids, of widows, of 
widowers, of old people generally, and of those who 
have a tendency to paralysis, especially in the lower 
limbs; likewise for children who appear to be pre- 
maturely old. 


General Action. — In massive doses it produces 
nausea, purging, and collapse. Its action upon the 
nervous system, detailed below, is secondary, and 
follows its continued administration in sinaller 

Brain and Spinal Cord. — Irritation of the cerebro- 
spinal axis, with painful spasmodic contractions of 
the abdominal muscles, and those of the lower ex- 
tremities; or clonic convulsions not limited to any 
single part, accompanied by loss of consciousness, 
and followed by a deep sleep. 

Mind. — Violent ; delirium, with great fear ; shrinks 
from any one who approaches (also Stramonium) ; 
or bites, strikes, and tears to pieces everything within 
reach, as does Belladonna. In lesser degree there may 
be restlessness and melancholy, with a constant sense 
of approaching misfortune. 

Sleep. — ^Very heavy ; almost a comatose condition, 
or intensely sleepy, and unable to rest. 

Accompaniments. — Spasmodic attacks of dysp- 
nea; chest feels contracted, almost to suflFocation; 


ineflfectual eflForts to vomit, with contraxitive pains in 
the stomach at intervals. 

Special Sphere of Action. — In some cases of idio- 
pathic epilepsy it has seemed to be of service, but is 
most useful in the spasmodic cramps in weak, nerv- 
ous individuals; those in whom mental or physical 
overwork has advanced to complete exhaustion. 
Reaction is deficient, and relapse follows the slightest 
indiscretion, until Cuprum starts the patient on the 
way to recovery. 


General Action. — Acts upon the cerebrospinal sys- 
tem, especially affecting the cardiac branch of the 
pneumogastric nerve. The first effect upon the heart 
is to strengthen the contractions and diminish the 
number of heart beats; the force of these contrac- 
tions being increased, exhaustion soon follows ; then 
the number of beats becomes greatly increased, with 
a marked decrease in their strength; this loss of 
strength may continue until paralysis results. 

Brain and Spinal Cord. — Headache, with conges- 
tion ; marked pulsations in the forehead (Cactus has 
pulsations in the top of the head); heavy, paralyzed 
feelings in the legs. 

Mind. — Anxiety, and fear of the future; low 
spirits, w^ith inclination to weep ; the eyes seem con- 
stantly floating in tears ; anxiety as from a troubled 
conscience; fear of death; fear that the heart will 
stop beating. 

Sleep. — Uneasy, unrefreshing sleep ; frequently 
startled, and awakes easily many times during the 
night (also Phosphorus). 

Accompaniments. — Constant urging to urinate; 
the urine is scanty, coffee-colored, and has a brick- 


dust sediment (also Lycopodium); extremely weak 
and rapid palse, or a slow, full, sluggish pulse. 

Special Sphere of Action. — Melancholia following 
masturbation; mental depression in cases of heart 
disease; insanity when the circulation is weak and 
greatly disturbed. 


General Action.— This drug produces marked 
changes in the condition of the blood ; under its in- 
fluence the number of red corpuscles is diminished; 
the watery portions of the blood are increased, while 
the albumen is decreased ; it produces a condition 
which Dr. S. Weir Mitchell has described as "fat 
anemia.*' The patients are weak, pale, and anemic, 
yet an appearance of flabby fiilness sometimes re- 

Brain and Spinal Cord. — Congestions of the brain, 
with sense of fiilness, and throbbing pains in the 
head (also Glonoin); worse after midnight; a feeling 
of paralysis in the lower limbs. 

Mind. — Muddled and confiised; depression of 
spirits in Tvomen, especially at the menstrual period ; 
anxiety and peevishness ; the slightest contradiction 
angers (also Chamomilla). 

Sfeep.— Sleepy, but unable to sleep (also Bella- 
donna and Gelsemium) ; feels sleepy usually as a re- 
sult of debility ; wakens frequently during the night 
(also Phosphorus), and feels weary, prostrated and 
unrefireshed in the morning (also Nux Vomica). 

Accompaniments. — General weakness and prostra- 
tion ; face pale, but flushes easily ; sometimes there is 
emaciation, at other times the fat remains, but in all 
cases there is great weakness; peculiar pallor of 
the countenance; menses too early and too pro- 


fiise ; diarrhea of hot, undigested stools ; while the 
patient is pale when quiet, the least excitement or 
motion produces rosy cheeks. 

Special Sphere of Action. — Hypochondriacal mel- 
ancholia ; weak and chlorotic women ; children w^ho 
are badly nourished, and prone to diarrhea. The 
form of iron from which we have obtained the best 
results has been the citrate. 


General Action. — It paralyzes the respiratory 
center in the medulla, and the motor nerves gener- 
ally, especially those of the eye. Under its influence 
there is a passive venous congestion. 

Brain and Spinal Cord. — Passive venous conges- 
tion of the cerebrum; brain feels bruised; great 
heaviness of the head ; dull, dragging pains in the 
occiput; scalp feels sore (also Arnica, Bryonia and 
Nux Vomica) ; giddiness ; drawing, contracting pains 
in the calves of the legs ; paralysis of the muscles of 

Mind. — Dull and stupid; the victim feels as if 
grossly intoxicated ; unable to think or fix the atten- 
tion ; fear of death, with moderate anxiety concern- 
ing the present. 

Sleep. — ^Drowsy, but cannot sleep; as soon as he 
falls asleep he becomes delirious and mutters while 
dreaming (also Cactus) ; sleeplessness, with a wide- 
awake but helpless feeling. 

Accompaniments. — Prostration of the whole mus- 
cular system; shooting, tearing, neuralgic pains 
along the tracts of the large nerves ; rapid and irreg- 
tdar action of the heart ; chilliness, followed by fever 
and stupidity. 


Special Svhere of Action, — Mental depression re- 
sulting from fright, from bad or exciting news, or 
from anticipation of coming trouble, as when a stu- 
dent contemplates the horrors of final examination. 
Neuralgia; convulsions; paralysis; epilepsy; hys- 
teria; rheumatic congestions; dysmenorrhea; and 
cerebrospinal meningitis. Gelsemium is especially ap- 
plicable to young and nervous people. It relieves 
sleeplessness in recent or incipient drunkards; in 
brain workers, in business men, and in those who 
have become suddenly exhausted by work or w^orry, 
or both. The Gelsemium patients present a heavy 
and besotted appearance. They are dull and stupid, 
and seem to be on the verge of heavy slumber, yet 
cannot sleep. 


General Action, — It dilates the arterial system, in- 
creases the fulness and rapidity of the pulse, and 
produces accelerated respiration, paralysis, loss of 
reflex action and sensation, and death from stop- 
page of respiration. 

Brain and Spinal Cord. — Head feels full to burst- 
ing, with violent throbbing, usually without severe 
pain, except when shaking the head; with slight 
motion sharp violent pains shoot through the brain 
(also Bryonia) ; the skull seems too small, and feels 
as if it would burst with every beat of the heart. 

Mind. — Ideas become confused; loses his way on 
familiar streets; does not recognize them; falls 
down, with loss of consciousness. 

Sleep. — Restless sleep, with confused dreams, yet 
diflScult to awaken. 

Accompaniments. — The whole action of Glonoin 
centers about its power to produce sudden and vio- 


lent changes in the circulation. It is characterized 
by a full strong pulse ; the arteries throbbing visibly 
as under Belladonna; and active congestions are 
seen in the hot, bright red skin which almost imme- 
diately follows its administration. 

Special Sphere of Action. — ^This remedy fits very 
closely and successfiiUy relieves the symptoms most 
characteristic of insanity foUowng sunstroke ; name- 
ly, confusion of mind, and incapacity for exer- 
tion, often with short outbreaks of frantic maniacal 
agitation. It is also useful in analagous symptoms 
arising from traumatism, and in the after effects of 
fright, fear, and mental excitement. 


General Action. — It is a pow^erful gastro-intestinal 
irritant, producing violent vomiting, purgmg, pain 
in the abdomen, collapse, stupefaction and convul- 
sions. It retards respiration, and paralyzes the 

Brain and Spinal Cord. — ^RoUs the head night and 
day; bores it into the pillow; dulness and heavi- 
ness in the head; head hot and heavy; the patient 
lies in a stupefied condition; lack of muscular co- 
ordination ; awkward ; objects fall from the hands 
(also Apis Mellifica). 

Mind. — Depressed ; thinks himself very unhappy ; 
obtuseness of the senses and mental faculties; is 
stubbornly silent; indiflFerent to pleasure or pain; 
has difficulty in collecting the thoughts, and an ab- 
sence of desire for action ; homesickness. 

Sleep. — Drowsy; sleeps heavily; interrupted by 
shrieks, and muscular twitchings ; confused dreams. 

Accompaniments. — Dropsical effusions into the 
serous cavities in the brain, chest or abdomen. Face 


bloated and distorted ; urine scanty, hot and turbid ; 
constant chewing motion of the jaws. 

Special Sphere of Actiofl.— Hellebore has always 
been a prominent remedy in the treatment of the 
various forms of meningitis. In certain apathetic 
melancholias, with sluggish circulation and passive 
cerebral congestion, it relieves the symptoms above 


General Action. — ^This drug produces enlargement 
and suppuration of the lymphatic glands, an un- 
healthy skin, ulcers, eczematous eruptions, and ca- 
tarrhal conditions of the mucous membranes. 

Brain and Spinal Cord. — Pain on one side of the 
head as if a plug or dull nail were driven into the 
brain (Ignatia and Coffea); a sense of swashing in 
the brain. 

Mind. - Low-spirited and irritable ; memory 
weak; he forgets words and places; dwells on 
former unpleasant incidents which make him feel 
discouraged (also Natrum Muriaticum); is even sui« 
cidal. The anxiety is greatest in the evening. 

Sleep. — ^Violent starts when falling asleep; excess- 
of thoughts keep him awake in the latter half of the 

Accompaniments. — Profuse mucous secretions, 
with sharp splinter-like pains ; great sensitiveness of 
all aflfected parts; cannot bear any pressure. The 
symptoms are all better with warmth, and made 
worse by exposure to cold. 

Special Sphere of Action. — Hepar Sulphur is one of 
the remedies less used among the insane for the direct 
control of mental symptoms than for the improve- 
ment of their physical state. Many other remedies 


have similar symptoms, but none other takes its 
place in the management and prevention of suppu- 
rative processes. It is also particularly indicated in 
the atonic dyspepsias, with a craving for stimulants 
and condiments. 


General Action, — It produces special effects upon 
the sensorium, causing hallucinations of sight, and 
great mental activity. In larger doses, it produces a 
temporary paralysis of the voluntary muscles, with 
partial obliteration of consciousness. 

Brain and Spinal Cord. — Cerebral congestion of a 
milder type than that produced by Belladonna; 
trembling ot the limbs ; spasmodic twitchings of the 
muscles of the back, and in the organs of locomo- 

Mind. — Delirium, accompanied by periods of 
stupor; thinks he is in the wrong place; foolish 
laughter; almost always jolly; talks in a hurried 
and cheerful manner ; intensely jealous ; at times las- 
civious; inclined to uncover the body and expose 
the sexual organs; sings amorous and obscene 

Sleep. — Sleeplessness from excessive mental excite- 
ment (also Bryonia and Coffea); sleepless without 
any apparent cause ; dreams of obscene things ; has 
dreams of a terrifying nature, and awakens with a 
loud scream. 

Accompaniments. — Retention of urine (also Can« 
tharis and Arsenicum); sometimes has involuntary 
discharges of urine (also Causticum); attacks of hic- 
cough (also Ignatia and Cicuta Virosa); spasmodic 
twitchings in various muscles; tendency to convul- 
sions; dry and spasmodic cough; involuntary 


Special Sphere of Action.— It is especially adapted 
to women who become insane during pregnancy or 
after parturition ; to those who suffer from jealousy 
or unhappy love ; to victims of delirium tremens ; 
and to young people and children who are inclined 
to convulsive attacks, to epilepsy, and to chorea. In 
general paresis it is frequently called for to control 
the delusions. This drug has been famous as a sleep 
producer for many years. Hyoscyamine and Hyos- 
cine, the active principles of the original drug, have 
been much experimented with, and perhaps have 
been used in too large and too frequently repeated 
doses to secure the best and most satifactory results. 
The Hyoscyamus patient is sleepless without appar- 
ent cause, save that the nervous system has become 
somewhat depleted, while at the same time the mind 
of the patient has been overworn by too long con- 
tinued or too active use. The Hyoscyamus patient 
has neither the anxiety of Aconite, the rage of Bella- 
donna, nor the stupidity of Gelsemium, but he dis- 
plays the individual characteristic of a jolly and 
wakefiil delirium. Hyoscyamus paints the mental 
town of its victim a brilliant and luminous red, and 
stimulates him to sing, in merriest and most vocifer- 
ous tones, the songs of Venus and Bacchus com- 


General Action, — It acts upon the cerebrospinal 
system, producing cerebral and spinal hyperemia, 
with great sensitivess of the nerves. 

Brain and Spinal Cord. — Headache; confusion; 
vertigo and heaviness; congestion of the spinal 
cord ; convulsions from a blow^ on the head. 

Mind. — Irritable ; inclined to speak sharply ; sees 


spirits and specters ; suffers from loss of memory ; 
intense depression after nerve injuries. 

Sleep, — Spasmodic jerkings of the limbs on going 
to sleep ; dreams of traveling. 

Accompaniments. — Tympanitic distention of the 
abdomen; great sensitiveness to external impres- 

Special Sphere of Action. — Mental depression fol- 
lowing all nerve injuries; convulsions, spinal aflfec- 
tions and lock-jaw following wounds of the nerves: 
Hypericum is said to be the Arnica of the nervous 
system, and in some cases this drug has seemed to 
have the power of arresting nerve degeneration, 
notably in one case of progressive muscular atrophy. 


General Action. — It acts upon the cerebrospinal 
nervous system, more especially on the spine, pro- 
ducing hyperesthesia of all the senses. 

Brain and Spinal Cord. — Congestive headache, 
following anger or grief, especially grief; headache, 
with bruised feeling, or a sensation as if a nail were 
driven in the temples ; occipital headache, better from 
pressure. Its effects upon the spine are shown by 
the sudden jerkings of the limbs, by twitchings of 
groups of muscles, by a feeling of heaviness in the 
feet, with a sensation of burning in the soles of the 

Mind. — Intense though partially suppressed grief; 
anxiety as if crime had been committed ; grief fol- 
lowing the loss of friends ; grief of children after be- 
ing reproved or punished by parents; fearfulness; 
irresoluteness ; timidity; sad, quiet, melancholy. 
Sometimes the Ignatia case is hysterical and hilari- 


ous temporarily; but soon subsides, and "weeps 
tears inwardly." 

Sltep. — ^Very light sleep ; jerking of the limbs on 
going to sleep ; dreams of one thing, particularly of 
the object of aflFection. 

Accompaniments. — Frequent sighing ; desire to 
take a deep breath ; sensitive spine ; sharp, constrict- 
ing pains in the anus ; constipation ; stools large and 
soft, but passed with difficulty; spasmodic cough 
from mental anxiety. 

Special Sphere of Action, — Ignatia is a remedy of 
great value in conditions of profound mental depres- 
sion, and the cases of melancholia in which it does 
not find a place during some period of their treat- 
ment are very few. It is particularly useful in ail- 
ments resulting from grief, the loss of friends, and 
bad news of any sort; the eflfects ol disappointed 
love; ailments of a nature which lead to concealment 
rather than publicity, and over which the patient 
broods in silence, with sad countenance, and frequent 
sighing ; griefs and troubles about which the patient 
can rarely be induced to talk, but from which he 
suffers often to the extent of unhinging his reason, 
and driving him to despair, and possibly to suicide. 
It is curative in long continued but suppressed sad- 
ness occasioned by family afflictions or by financial 
misfortunes ; in chorea or epilepsy in children whose 
troubles are occasioned by feeling that they have 
been unkindly or harshly treated. In general paresis 
it relieves when there is long continued depression of 
mind with inclination to mourn and brood over the 
past, while he also cherishes dark apprehensions 
relative to the fiiture. The Ignatia patient not only 
broods and mourns, but likewise has attacks of gen- 
eral restlessness, when he wrings his hands and 


trembles a good deal. It is useful in hysterical aflfec- 
tions when there appears to be great sensitiveness 
to external impressions, alternate laughing and cry- 
ing, cold extremities, accompanied or followed by 
the passage of large quantities of pale urine. (Also 
Gelsemium and Phosphoric Acid). There is severe 
pain in the head of the character known as clavus 
hystericus. This remedy alone has proven curative 
in numerous cases of melancholia, particularly for 
women, where it seems to do better than for men. 
With men, Arsenicum or Nux Vomica appears to act 


General Action, — Its action through the sympa- 
thetic nervous system is upon the glandular organs, 
in the first instance stimulating their ftinctions, and 
increasing their secretions ; and secondarily, produc- 
ing atony and advanced or complete atrophy. 

Brain and Spinal Cord. — Headache as if a band 
were drawn tightly around the head; worse with 
active exertion, as walking rapidly; sometimes a 
feeling of paralytic weakness in the arms; vertigo on 
the left side only. 

Mind. — Restless ; constantly moving about ; 
changes his seat frequently; over careful; fears an 
unfavorable outcome to every little occurrence (com- 
pare Calcarea Carbonica and Arsenicum); shrinking 
and fear when any one comes near; low-spirited; 
irritable and sensitive, especially during digestion. 
The patient may feel that the brain is stirred up, 
and that he must keep in constant motion, or go in- 

Sleep. — Restless after midnight, with vivid, an'x- 


ions dreams ; feels constantly as if she had forgotten 

Accompaniments. — Hoarseness or complete apho- 
nia, with dry croupy congh or wheezing respira- 
tion, pulmonary congestion ; chronic diarrhea, with 
bloody mucous stools; enlargement of the thyroid 
gland, especially if soft, with swelling of the other 
glands of the neck. 

Special Sphere of Action, — Iodine is most success- 
ful in elderly persons, with dark hair and eyes, and 
with a tendency to rapid emaciation. It is indicated 
in the melancholia of the aged, and in those weak- 
ened by the scrofulous diathesis, or succumbing to 
cretinic conditions. Its remarkable power in resolv- 
ing and dissipating morbid hypertrophies and cellu- 
lar new growths renders it, especially in combina- 
tion with Potassium, of prime service in the organic 
insanities brought about by the lesions of tertiary 
syphilis in the central nervous system. 


General Action. — This drug acts upon the blood, 
and produces decomposition and defibrination of 
that fluid; consequently Lachesis induces hemor- 
rhages, abscesses, malignant inflammation, gan- 
grene, and pyemia. Upon the nervous system it pro- 
duces two characteristics : hyperesthesia and intoler- 
ance to pressure in all parts of the body, and the ag- 
gravation of all symptoms after sleep. 

Brain and Spinal Cord. — Intense pressive head- 
ache, extending from the frontal region to the base 
of the brain and to the nose ; the headache is accom- 
panied by nausea and vertigo on w^aking in the 
morning; there is great weakness in the arms and 
legs ; with the weakness and exhaustion there is sen- 


sitiveness to all external impressions, and the slight- 
est constriction around the neck or chest or waist is 

Mind. — Mental activity, with a tendency to talk 
much; yet the mind is weak and erratic, and the 
victim makes many mistakes if he attempts any in- 
tellectual work; lack of mental continuity; con- 
stantly changing from one subject to another ; jeal- 
ousy; hallucinations of frightful images. The La-^ 
chesis patient thinks himself under superhuman 
control ; also thinks himself dead, and that prepa-- 
rations are being made for a gaudy funeral. 

Sleep. — Wide awake in the evening ; restless sleep, 
disturbed by dreams ; tossing about in sleep ; great 
sleepiness, but unable to sleep (also Belladonna and 

Accompaniments. — Dimness of vision, with black 
spots before the eyes ; lefb-sided tonsillitis ; diflSiculty 
in swallowing liquids ; sensitiveness of throat ; sen- 
sitiveness of internal organs, as well as sensitiveness 
upon the surface of the body; scanty and feeble 
menses, with dark, bloody discharges ; extreme sen- 
sitiveness of the uterus, particularly at the menstrual 
flux and during the climacteric period ; general left- 
sided pains, with great sensitiveness. 

Special Sphere of Action. — It is particularly ser- 
viceable in the mental depressions which sometimes 
occur in women at the climactric period ; the patient 
is often loquacious, and jumps from one subject to 
another in conversation. It seems to be useful in 
certain cases of neurasthenia, where it aids in arous- 
ing the patient from an apathetic or indifferent con- 
dition, and giving him his first start toward re- 
covery. It is called for in insanity following fevers 


of a low type, and left-sided paralysis (also Arnica 
and Lycopodium). 


General Action. — It acts upon the heart and 
causes cardiac irritability, with palpitation. It also 
produces venous congestions, most pronounced in 
the female generative organs. 

Brain and Spinal Cord. — Dull headache over the 
left eye, or alternating from side to side ; fulness of 
the head, as if its contents would be pushed out at 
every aperture ; heat in the top of the head ; vertigo, 
which is better in cool air ; the whole body feels sore 
as if pounded (also Arnica and Eupatorium Per- 

Mind. — Great fear, and dread of insanity (also 
Sepia and Calcarea Carbonica) ; fear that should she 
become insane no one would care for her; loss of 
memory ; uses wrong words ; desire to do something 
with hurried manner, but unable to accomplish any- 
thing. Sometimes from depression and anxiety the 
Lilium patients pass into a mental state where they 
become peevish and fretful, and where they are in- 
clined to curse and talk in an obscene manner. 

Sleep. — Inability to sleep, worse before midnight ; 
restless sleep, and wild feelings in the head ; frightful 
dreams; everything seems hot, particularly in the 
region of the genitals ; twitchings of the legs on fall- 
ing asleep. 

Accompaniments. — Menses too late and scanty; 
bearing down in the uterine region, with a feeling as 
if everything were coming out (also Sepia and Bella- 
donna) ; ftinctional disease of the left ovary, accom- 
panied by stinging, cutting, grasping pains; heart 


feels as if squeezed by a vise, and as if the blood had 
been all pressed out. 

Special Sphere of Action, — Melancholia with ex- 
citement, preceded by ovarian and uterine diseases, 
and by functional disturbances of the heart ; mental 
disturbances following subinvolution of the uterus ; 
depression of mind after severe and exhausting 


General Action. — ^This drug acts upon the vegeta- 
tive system, producing weakness of its powers, and 
wasting and decay of the tissues. It acts also upon 
the liver and the digestive tract in such a way as to 
cause hepatic congestions, constipation, indigestion, 
and marked accumulations of flatulence. 

Brain and Spinal Cord. — Pressing frontal head- 
ache, especially right side of the head (Lachesis head- 
ache is on the left side) ; the Lycopodium headache 
is worse from 4 to 8 p. m.; pressive headache in the 
vertex (Cactus has throbbing in the vertex) ; under 
Lycopodium the hair becomes gray too early in life ; 
it induces falling out of the hair and causes baldness; 
burning pains between the scapulae; pain in the 
small of the back ; drawing, tearing pains in all the 
limbs ; stiffness and painfullness of the joints ; cramps 
in the calves of the legs ; sensation as if a tight band 
were bound around the body at the umbilicus ; sen- 
sation of a band about the head (also Mercurius). 

Mind, — Great depression of spirits ; very sad, de- 
sponding and anxious ; doubts about salvation (also 
Sulphur and Veratrum) ; weakness of memory, with 
confusion of thoughts; when the digestive organs 
are much disturbed, the patient is fretful, irritable 

and morose, or he may become vehement and angry 


if crossed in his purpose or desires ; at times is im- 
perious and domineering in manner; thinks himself 
of much importance (also Belladonna, Cuprum, Pla- 
tina, and Veratrum). 

Sleep. — Sleepy during the daytime, wakeful at 
night, sleep restless; cries and starts in sleep (also 
Chamomilla and Antimonium Crudum); unrefresh- 
ing sleep; feels blasS in the morning (also Nux 
Vomica) . 

Accompaniments. — Fulness and distention of the 
abdomen, with flatulence; frequent eructations; 
variable appetite ; considerable hunger, but a small 
quantity of food produces sensations of fulness 
(also Cinchona and Sepia) ; red sediment in the 
urine (also Digitalis); general aggravation from 4 
to 8 p. M. 

Special Sphere of Action. — Melancholia, accom- 
panied by dyspepsia, flatulence and constipation; 
subacute mania, with indigestion, chronic hepatitis^ 
and catarrh of the bladder, and chronic rheumatism; 
mental disturbance in the latter stages of phthisis 
pulmonalis; emaciation from lack of pow^er to as- 
similate food, and accompanied by night sweats. 


General Action. — Acts upon the entire organism, 
but especially upon the vegetative system, producing 
depressions of functional power, and decomposing 
and disintegrating the organic constituents of the 
body; secretions and excretions are increased, but 
the secretions become thinner than normal, and the 
excretions become acrid and excoriating. 

Brain and Spinal Cord. — Congestion of the brain, 
with feeling of a band about the head (also Lycopo- 
dium); the scalp is painfiil to the touch (also Nitric 


Acid, China, Nux Vomica and Arnica); weakness 
and trembling in the limbs and back, worse at 
night ; cold extremities. 

Mind. — Great weakness of memory ; loss of sense 
of decency ; delusions concerning food ; eyes dull and 
staring; under the influence of impaired vision he 
becomes suspicious and distrustful of those about 

Shep. — Sleepy during the dajrtime, but sleepless 
at night, because all pains in the Mercurius patient 
are aggravated at night. 

Accompaniments, — Pale face; swollen tongue and 
gums; loss of teeth; profuse, watery discharges 
from the mouth ; a sluggish condition of the abdom- 
inal organs ; foul breath ; pain and soreness of all 
the muscles; bone pains at night and in damp 

Special Sphere of Action. — The various mercurial 
preparations are frequently of use in the treatment 
of demented or depressed conditions, following scrof- 
ulous, syphilitic, rheumatic, and catarrhal affections. 
The constitution seems to be deeply affected; the 
blood is impoverished, and the body wastes. There is 
frequently hectic fever; the skin ulcerates easily; the 
patient is sleepless, and troubled with twitchings of 
the Umbs and the characteristic Mercurial tremor. In 
general paresis it is indicated when there is a general 
heavy and soggy condition of the system; the 
patient is inclined to be filthy in body and groveling 
mentally, and inclined to rambling incoherence or 
apathetic dementia. Experience seems to teach that 
Mercurius acts better in acute cases when preceded 
by a few doses of Aconite. It is a drug whose gen- 
eral action covers those mental states which natu- 
rally follow disorganization of the physical system 


by diseases which are the result of exposure to the 
worst types of both weather and women. 


General Action. — It acts upon the vegetative sys- 
tem, upon the blood, upon the digestive tract, and 
upon the spleen. Normally, salt is present in every 
tissue of the body, and this is not to be wondered 
at, for we use it in almost every article of food. 
When taken in excess it is highly irritative and dis- 
organizing in its action, and leaves no organ unaf- 
fected. Soldiers, sailors and Arctic explorers, and all 
who are obliged to live upon very salt food, event- 
ually have catarrhal discharges from all the mucous 
surfaces; thence they pass into a condition known 
as scurvy; the body emaciates, the blood becomes 
thinned and is defibrinated; and the bones them- 
selves become tender and brittle. 

Brain and Spinal Cordf.— Pulsating headache in 
the vertex every morning; stupefying headache, 
with nausea; the headache recurs every day at a 
certain hour; the hair falls out, and the scalp 
becomes sensitive ; there is pain in the small of the 
back, as if broken; the limbs are weak, trembling, 
and paral3rtic. 

Mtncf.— Sadness and depression of spirits, aggra- 
vated by sympathy; aversion to men (a very ab- 
normal feminine symptom); profuse weeping fol- 
lowed by loss of memory ; difficulty in grasping and 
retaining one's thoughts. 

Sleep, — Falls asleep late at night, and awakens 
early in the morning ; uneasy, anxious sleep ; the pa- 
tient sobs and cries even while sleeping. 

Accompaniments. — Blisters on the lips; violent, 


unquenchable thirst ; emaciation, even with an enor- 
mous appetite ; copious discharges of light urine. 

Special Sphere of Action. — Melancholia following 
intermittent fevers, especially those cases which have 
been overdosed with quinine ; mental impairment in 
young persons who have suffered with imperfect de- 
velopment and from scorbutic affections; mental 
depression in girls affected with chlorosis, or profiise 
leucorrhea ; mental diseases of an intermittent type. 


General Action. — Nitric Acid, whether applied 
locally or administered internally, is destructive in its 
action. Its effects are seen in the blood, glands, 
bones, skin, mucous membranes, and most charac- 
teristically at the various muco-cutaneous junctions, 
as the mouth or anus. 

Brain and Spinal Cord, — Rush of blood to the 
head ; pulsating headache as if the head were tightly 
bound up as in a vise (compare Antimonium Tar- 
taricum, Gelsemium, and Mercurius). 

Mind. — Discontented, and inclined to weep vio- 
lently ; despondent moods ; easily discouraged or ir- 
ritated, and vexed by Uttle things unworthy of 
notice ; anxious about himself; mental work is diffi- 
cult and distastefal. 

Sleep, — Wakens too early in the morning; dis- 
turbed by dreams of crimes, dangers, or death. 

Accompaniments. — Ragged, unhealthy ulcers, with 
thin, excoriating, ichorous discharge ; thin, irritating 
nasal catarrh; pains in all parts of the body, as 
though a splinter or piece of glass were sticking in 
the flesh ; offensive green, undigested diarrhea passed 
with much straining. 


Special Sphere of Action. — This is a deep acting 
constitutional remedy best indicated in scrawny, 
thin, dark-skinned persons debilitated by the action 
of some violent dyscrasia, usually of protracted du- 
ration. It is useful in the secondary stage of syphilis, 
especially if an excessive amount of Mercury has 
been previously given. It is a leading remedy for the 
despondency, mental weakness, and irritability 
which attend profound physical disease. 


General Action. — It acts especially upon the spinal 
cord, causing an excitability of both motor and 
sensory centers ; it produces tetanic convulsions and 
rigid flexions of the body, such as opisthotonos ; it 
also produces spasmodic contractions of the muscles 
of the throat, of the face, and of the intestinal and 
urinary tracts. 

Brain and Spinal Cord. — It produces congestion 
of the brain, and stupefaction. This drug produces a 
feeling as if the victim had indulged for a long time 
in a heavy debauch; there is a dull, heavy pain 
throughout the head, and especially over the left eye 
or in the occiput ; there are spasms of the muscles on 
the neck, back and limbs, sometimes so severe that 
the patient stands upon his head and heels with 
body curved upward. 

Mind. — Intense irritability; disposition to find 
fault with everything; quarrelsome; vindictive, ill- 
humored (also Bryonia); oversensitive to external 
impressions; cannot tolerate light or noise (also 
Belladonna), music or strong odor; inclination to 
kill beloved friends; inclined to commit suicide, but 
too cowardly to consummate his desires; extreme 
sensitiveness to the words and attention of others. 


Sleep. — After long continued mental exertion, the 
Nux Vomica patient is sleepless from an inability to 
compose the mind and disengage himself from atten- 
tion to the business he has had in hand ; falls asleep 
late at night; wakens at three a. m., lies awake tos- 
sing and fretting for two or three hours, falls asleep 
when he should get up, and after a short morn- 
ing nap awakens unrefreshed and ill tempered, his 
anger rising against himself and those around him. 

Aecompaniments. — Photophobia, aggravated in 
the morning ; nose plugged with mucus on awaken- 
ing, followed by profuse watery discharges after the 
nostrils are relieved of the plug ; besotted expression 
of the face ; bitter eructations, with nausea in the 
morning; pressure and pain in the stomach after 
eating ; constipation with ineffectual urging. 

Special Sphere of Action. — This remedy is espe- 
cially indicated in behalf of nervous people of seden- 
tary habits ; also so-called bilious people, and those 
who suffer from chronic dyspepsia, from chronic con- 
stipation, and from chronic hypochondriacal melan- 
cholia; mental depression from overstudy, from 
overanxiety , and from overdrinking ; loss of mental 
power from masturbation, and from excessive in- 
dulgence with those of the opposite sex. It produces 
favorable results in the cases of many people who 
suffer from hard work, personal neglect, unnaturally 
irascible tempers, drinking and debauchery, mental 
depression, and from pessimistic views of life. Its ad- 
ministration is efficacious in the relief of sleepless- 
ness in such patients as we have just described, if 
they will simply reverse their methods of living, and 
correct their daily habits, and make them conform, 
to a reasonable extent, with the simple but positive 
requirements of nature. 



General Action. — It produces a general depres- 
sion, torpor and paralysis of functional activity ; it 
befogs the mental faculties, impedes the action of the 
heart, and diminishes the secretions of the mucous 

Brain and Spinal Cord. — Congestion of the brain ; 
vertigo, as if intoxicated ; pressive pains in the. head 
and cold sweat upon the forehead ; cold extremities, 
numbness and trembling of the limbs ; spasms in the 
muscles of the back, causing the spine to curve like 
an arch. 

Mind. — Dulness, stupidity, loss of consciousness; 
the patient acts as if in a drunken stupor ; again, the 
patient becomes delirious, and has hallucinations of 
sight, and sees frightfiil visions ; vivid imaginations ; 
exaltations of mind; thinks herself away from 
home; apprehensive and frightened at seeing small 
animals ; marked inability to tell the truth ; Opium 
eaters are cunning and inveterate Uars. 

Sleep. — Deep, heavy sleep that is unrefreshing ; 
sleeplessness from extreme sensitiveness of the special 
senses; sleepless but stupid (also Gelsemium). 

Accompaniments. — Chronic constipation from 
paral3rtic inactivity of the bowels ; apoplectic condi- 
tions; spasmodic griping, pressive pains in abdo- 
men ; slow respiration ; slow pulse with sharp pains 
through the chest. 

Special Sphere of Action.— This drug is homeo- 
pathically applicable in the treatment of those who 
have long been dissipated; old people who are in- 
clined to apoplexy or paralysis ; melancholia, when 
the patients are at one time stupid and depressed. 


and again restless, anxious and troubled with vivid 
hallucinations of sight. 


General Action, — Acts upon the vegetative sys- 
tem, producing waste of tissue, and marked disturb- 
ance of the kidneys and male sexual organs. Under 
Phosphoric Acid the male sexual organs become re- 
laxed, and unable to perform their natural ftinctions. 

Brain and Spinal Cord, — Sense of depression, with 
confusion and dulness of the brain ; weakness in the 
back and limbs. 

Mind. — Absolutely indifferent to surroundings ; 
unable to think ; disinclined to talk ; loss of memory ; 
questions are answered very slowly. 

Sleep. — Drowsy and apathetic night and day, but 
sleepless after midnight. 

Accompaniments. — Profuse urination ; loss of ap- 
petite; weakness of sexual organs; debilitating emis- 
sions ; exhaustion after coition or masturbation. 

Special Sphere of Action. — Dementia from mastur- 
bation, or from sexual excesses; palpitation of the 
heart in young people ; melancholia from disappoint- 
ment in love, from excessive menstruation, and from 
physical exhaustion due tooveraction of the kidneys. 


General Action. — It inflames and degenerates the 
mucous membranes of the entire alimentary tract; it 
produces an active parenchymatous degeneration of 
the liver; it destroys bone, expecially the inferior 
maxilla and tibia ; it causes fatty degeneration of all 
tissues of the body, leads to purpuric extravasations 
through disorganization of the blood ; produces san- 


guineous infiltrations of lung tissue, and inflames the 

Brain and Spinal Cord, — Softening of the brain 
and spinal cord, with persistent headache; acute 
atrophy of the brain and the medulla oblongata; 
congestion of the brain, with throbbing of the tem- 
ples ; heat and burning in the brain and spine ; weak- 
ness and heaviness in the limbs. 

Mind, — Apathy, stupidity, indiflference to every- 
thing; indisposition to mental or physical exertion 
(also Nux Vomica and Sulphur) ; ideas slow in evo- 
lution ; inability to think ; occasionally nervous, fear- 
ful and hysterical. 

Sleep, — Sleepless before midnight ; falls asleep, but 
awakens easily many times during the night. 

Accompaniments. — Hoarseness; hollow, spas- 
modic cough ; expectorations streaked with blood ; 
short, labored respiration ; great weakness, prostra- 
tion and emaciation. 

General Sphere of Action, — Insanity from mastur- 
bation or excessive sexual indulgence; insanity re- 
sulting from phthisis; cerebral softening; spinal 
softening; locomotor ataxia; paralysis following 
wasting diseases. It tends to delay the processes of 
cerebral degeneration, and hence it is of great value 
not only in relieving the sleeplessness of those suffer- 
ing with organic brain disease, but it tends to ward 
off" and hold in check approaching apoplexy and pa- 
ralysis. It is sometimes combined with other drugs ; 
and a useful constitutional remedy, and a nutrition- 
improving remedy is found in Calcarea Phosphorica. 
Also the brain fag of strong but overtaxed mental 
workers is relieved by the use of Phosphide of Zinc. 
But Phosphorus itself is a wonder-working brain 
remedy if judiciously applied. The sleeplessness of 


Phosphorus is characterized by short naps, and fre- 
quent wakings during the night. 


General Action. — Acts upon the nerve centers, pro- 
ducing depression of the sensorium and derangement 
of the entire nervous system. 

Brain and Spinal Cord, — Sensation of numbness 
or coldness in the head ; sensation in the temples as 
if the head was tightly bound, or as if the various 
parts were closely screwed together; sensation of 
cold spots on the temples. 

Mind. — Full of unnecessary pride ; looks with con- 
tempt upon those around her ; fancies herself great, 
and that her neighbors are small, insignificant and 
weaker than herself in both mind and body ; at times 
depressed, inclined to weep, feels lonesome, but too 
proud to associate with her friends. 

Sleep. — Indulges much in spasmodic yawnings ; is 
very sleepy, but sleep is light and often broken. 

Accompaniments. — Inflammation of the ovaries, 
with paroxysms of burning pain; sensitiveness of 
the female genital organs; voluptuous inclinations^ 
with anxiety and palpitation of the heart. 

Special Sphere of Action. — Mania with pride ; mel- 
ancholia complicated with hysteria; nymphomania 
due to inflammation of the ovaries. This drug is 
especially adapted to the treatment of hysterical 
females. It is often given for monomanias of pride 
and grandeur. These patients are haughty and dic- 
tatorial, overbearing and faultfinding; look down 
disdainfiiUy on others. 



General Action. — Its chief action is upon the ab- 
dominal viscera, resulting in a profuse, forcibly ejected 
diarrhea, and a secondary torpor, and congestion of 
the liver. Reflexly, symptoms of cerebral irritation 

Brain and Spinal Cord, — Vertigo, with sensation 
of falling forward; headache; rolls the head and 
moans; pain between the shoulders, and along the 
spine in the morning. 

Mind. — ^Depression of spirits ; imagines that he is 
going to die ; has a disgust for life on account of tor- 
menting gastric difficulties. 

Sleep. — Heavy sleep; vertigo on awakening; 
moaning in sleep (also Belladonna). 

Accompaniments. — Diarrhea, with frequent, yel- 
low, painless stools; stools with a meal-like sedi- 
ment; sour smelling stools, with flatulence; bloody 
stools, with prolapsus ani; diarrhea worse in the 
morning. On the other hand, there may be constipa- 
tion, with clay-colored or chalky stools (Mercury); 
general appearance of jaundice; dyspepsia; yellow 
coated tongue; alternation of diarrhea and consti- 
pation (also Nux Vomica). 

Special Sphere of Action. — Hypochondriacal mel- 
ancholia following abdominal disorders, or accom- 
panied by diseases of the digestive organs. 


General Action. — Pulsatilla, through the cerebro- 
spinal system, works its effects upon the mucous and 
serous membranes, upon the veins, upon the gener- 
ative organs of both sexes, upon the ears and eyes. 


Among its general effects are increased catarrhal dis- 
charges from all mucous surfaces. 

Brain and Spinal Cord, — The brain symptoms 
seem to rise by reflex action from diseased conditions 
of other organs of the body ; there is headache, with 
suppression of the menses; headache from over- 
loaded stomach, especially after eating fat food; 
headache after catarrh of the nasal and bronchial air 
passages ; stiffness and rheumatic pains in the nape 
of the neck ; pain in the small of the back as from a 
sprain; hip joint painful as if dislocated; drawing, 
tensive pain in the thighs and legs. 

Mind. — Constant inclination to weep; gentle, 
timid and yielding disposition ; at the same time fret- 
ful, morose, and easily put out of sorts. Fretfulness 
and fearfulness are the chief characteristics of the 
Pulsatilla patient. 

Sleep. — Sleeplessness from effects of late suppers, or 
from eating too much ; sleepless the first half of the 
night ; sleeps freely toward morning ; screaming and 
whining in sleep on account of vivid or frightful 

Special Sphere of Action. — Pulsatilla is a remedy 
of frequent service among insane women who suffer 
with disordered menstruation. Pulsatilla patients 
are of a mild, gentle, yielding disposition, disposed to 
cheerfulness, and yet manifesting a changeable and 
fickle disposition, often smiling in the midst of tears. 
When the menses are delayed or absent, Pulsatilla is 
of great service in establishing the flow, and among 
insane women this is frequently followed by improve- 
ment in the mental symptoms. Religious melan- 
cholia, especially in women who are weak in body, 
and anxious and apprehensive in mind. It is espe- 
cially applicable to those states of hypochondriacal 
depression preceded or accompanied by profiise ca- 


tarrhal discharges, and by inflammatory conditions 
of the genital organs in both sexes ; acute glandular 
affections, particularly in the breasts and testicles; 
recent gastric disorders ; inflammatory states of the 
eye and ear. 


General Action, — Acts upon the cerebrospinal 
system; upon the skin, the lymphatic glands, and 
the muscular tissues ; it produces conditions simulat- 
ing rheumatism, erysipelas, and typhus fever. 

Brain and Spinal Cord. — Congestive headache^ 
with burning in the ears and vertex ; vesicular erup- 
tions upon the scalp; fulness and heaviness, and 
sensation of weight in the forehead ; rheumatic pains 
in the back and joints of the shoulder, arm and 
wrist ; fulness and pain in the limbs on first moving 
in the morning; relieved by constant motion. 

Mind. — Absence of mind; forgetful, difliculty in 
remembering the most recent events; apprehensive- 
ness ; anxiety, with restlessness ; cannot stay in bed ; 
delirium ; thinks he is walking over large fields ; sui- 
cidal and wants to drown herself; fears she is being 

Sleep. — Repeated yawning, without being sleepy ; 
dreams of taking severe exercise, and awakens very 
much exhausted as a result of these dreams. 

Accompaniments. — Diseases of a rheumatic na- 
ture ; erysipelas, with mild delirium ; eruptions upon 
the skin of a vesicular type ; great debility, with 
restlessness ; fever of a rheumatic type, with marked 
cerebral disturbance. 

Special Sphere of Action.— Mental depression in 
rheumatic patients, with great physical restlessness ; 


delirium accompanying diseases which result from 
exposure to storms. 


General Action. — Acts upon the cerebrospinal sys- 
tem, and upon the great sympathetic system; it 
afiFects the vasomotor nerves and causes contrac- 
tion of the coats of the blood vessels. The contrac- 
tions are followed by relaxations and by irregular 
dilations of the blood vessels. Secale also produces 
blood disorganization, and gangrene of the extremi- 

Brain and Spinal Cord. — Congestion of the brain, 
and vertigo ; subsequently, it causes cerebral and 
spinal anemia ; pain and confasion in the head ; sen- 
sation as if the contents of the skull w^ere being 
washed about; spinal paralysis with rapid emaci- 
ation ; spasmodic jerkings of paralyzed limbs ; pain- 
ful contractions of flexor muscles ; tingling in limbs ; 
sensation as if ants were crawling over the skin. 

Mind. — Apathetic, stupid, unable to think quick- 
ly ; from a dull mental state the patient sometimes 
rises to a condition of mania with inclination to 
bite. Again, there is great depression of mind, with 
sadness and fear of death; yet with this fear of 
death there are, oftentimes, suicidal tendencies (also 
Arsenicum), especially by drowning. 

Sleep. — Drowsiness; stupor, with frequent yawn- 
ing ; great inclination to sleep, but sleep is disturbed 
by frightful dreams. 

Accompaniments. — ^Uterine hemorrhage; prostra- 
tion of strength; tendency to emaciation; small, 
rapid, and sometimes fluttering pulse; anxious, 
labored inspiration, with constant tendency to sigh ; 


cold extremities; cramps in limbs, and sometimes 

Special Sphere of Action, — This drug is particu- 
larly adapted to the relief of mental diseases occur- 
ring in weak and scrawny women, in feeble and aged 
persons, or in those who have become, by effects of 
disease, prematurely old. It is useful in mental de- 
pressions after hemorrhages and other exhausting 
bodily disorders. 


General Action. — It acts apparently upon the great 
sympathetic system; it produces congestive effects 
upon the female sexual organs, and upon the liver. 
It also induces cerebral anemia. 

Brain and Spinal Cord. — Boring headache accom- 
panied by vertigo ; shooting pains in the head ; hemi- 
crania; sensation as if the head would burst; ag- 
gravated by stooping, coughing, or motion ; pain in 
small of the back, with much stiffness ; pain relieved 
by walking (also Rhus Toxicodendron); heaviness 
and weakness of the limbs. 

Mind. — Sensitive and sad ; much inclined to weep 
(also Natrum Muriaticum and Pulsatilla) ; at times 
apathetic and indifferent; again fretfal and easily 
offended ; dread of being alone ; apprehensive of the 
fiiture, and has great fears concerning her health. 

Sleep. — Sleepy during the da3rtime and early in 
the evening; awakens at three a. m., and cannot 
sleep again; (Nux Vomica patient wakens at three 
A. M., but after a time falls asleep, and sleeps till late 
in the morning) ; talks loudly in sleep ; sleepless from 
rush of thoughts ; awakens at night, with palpita- 
tion and anxiety about things that happened years 


Accompaniments. — Yellow^, waxy complexion, 
with general puflFed appearance of the face; yellow 
spots on the skin ; pains in the uterus, with a sensa- 
tion as if the contents of the pelvis would protrude 
through the vulva. Dyspepsia, with an all-gone sen- 
sation in the pit of the stomach ; excessive prostra- 
tion after uterine disease. 

Special Sphere of Action. — Sepia is a valuable 
remedy for mild cases of melancholia in chlorotic, 
puffy, and pot-bellied women, and for those who 
have suffered from miscarriages, from difficult labors, 
from profuse menses, and from chronic leucorrhea. 
It is valuable for mental depression following the 
condition known as subinvolution of the uterus. 


General Action.— It acts upon the sympathetic 
system, and produces marked eflfects upon the glan- 
dular structures, the bones, and the mucous sur- 
faces. Silicea has a marked control over the sup- 
purative process. 

Brain and Spinal Cord. — Headache from conges- 
tion of the brain, with excessive sensitiveness of the 
nervous system; headache aggravated by noise, 
motion and stooping ; headache produced by the ex- 
citement of the passions; the headache is severe, 
throbbing, shooting and burning in character; the 
Silicea headache is usually circumscribed, and may 
effect the occiput, the vertex, or the forehead ; the 
Silicea headache is relieved by warmth, and by care- 
fiiUy binding up the head with a cloth (also Ar- 
gentum Nitricum) ; the spine is sensitive to touch ; 
there is formication of the limbs, and a feeling of 
weakness in walking, produced by spinal debility. 

. Afinc?.— Weak-minded ; desponding; low-spirited; 


wishes to drown herself; compunctions of conscience 
about trifles ; yielding disposition ; faint-hearted ; has 
no "sand.** 

Sleep, — Somnambulism; has anxious dreams of 
murder; has lascivious dreams; jerkings of the limbs 
during sleep. 

Accompaniments. — Abdomen hard and tense ; con- 
stipation; attempts at stool are but partially suc- 
cessful ; swollen and hardened glands ; great debility ; 
ulcers, with stinging burning, pains; small wounds 
heal with great difficulty. 

Special Sphere of Action. — It is indicated in pro- 
found melancholia with symptoms like the forego- 
ing; in melancholia accompanied by boils, carbun- 
cles, abscesses, ulcers, or swollen glands. When we 
wish to remove or relieve deep-seated and long-last- 
ing effects of defective assimilation, we think of 
Silicea. It corresponds well with what the older 
writers called the "scrofulous diathesis," attended 
by suppurative processes affecting either the glands 
or the osseous system. It is also a safe and useful 
remedy in epilepsy, where the causes arise from mal- 
development, and where aggravations occur either 
weekly or monthly. 


General Action. — It produces enlargements and 
indurations of the ductless glands, especially the 
thyroid, with irritation of the trachea and larynx. 

Brain and Spinal Cord. — Congestion of the brain ; 
dull headache on the right side ; sharp stitches in the 
temples ; painfiil stiffness in the muscles of the neck 
and back ; twitchings in the muscles of the limbs ; ex- 
haustion and heaviness of the body after the slight- 
est exertion. 


Mind, — Irresistible desire to sing; the Spongia 
patient is jolly like Hyoscyamus, but the gaiety of 
spirits is longer continued and less variable than in 

Sleep, — Sleepy during the day; sleep interrupted 
by dreams at night. 

Accompaniments, — Great difficulty in breathing; 
hoarse, hollow cough; the patient is wheezing and 
asthmatic, and yet constantly inclined to sing. 

Special Sphere of Action, — Mania, with gaiety of 
spirits; women and children who are lighthearted 
^nd hopeful, but who have strong tendencies to 


General Action, — Acts upon the sensorium, stimu- 
lating it to undue activity, and inducing hallucina- 
tions of sight and hearing of the most vivid char- 
acter; it also produces suppression of urine; great 
«exual excitement; tendency to convulsions; fiery 
eruptions of the skin, and dryness of the throat, with 
fear of water. 

Brain and Spinal Cord, — ^Violent congestion of 
the brain ; excessive heat in the head ; pulsations in 
the forehead, but less violent than those Induced by 
Belladonna; twitchings of the hands and feet, and 
trembling of the limbs; cataleptic states. 

Mind. — Extraordinary mental excitement ; sudden 
^nd kaleidoscopic changes in the mental state; at 
times fuU of horrible fears ; at times merry, and en- 
jojring himself by singing and dancing; at times 
proud, haughty, and intolerant of those around 
him; at times fall of rage, trying to strike with 
^eat vigor those within his reach ; and again, dul- 
ness of the senses, with stupid indifference to every- 


thing about him. Fear and hope, jollity and rage^ 
frenzy and apathy follow each other in rapid succes- 
sion under Stramonium; the passions and the 
mental manifestations become strangely jumbled 
in their exhibition under the influence of this stimu^ 
lating drug. The Stramonium patient desires light 
and company, and at the same time is often terrified 
by bright objects, and seeks to fight those whom 
he constantly wishes to have in his presence. He 
has hallucinations of sight during which horrible 
images are conjured up, and horrible animals are 
seen jumping out of the ground and running at their 
affrighted victim. 

Sleep, — Deep, heavy sleep, with snoring or stertor- 
ous breathing; the heavy sleep is short, and the 
patient is often roused, apparently by seeing horrible 
objects in his dreams ; twitching and cramping dur- 
ing sleep. 

Accompaniments. — Suppression of urine ; convul- 
sions from the sight of bright objects ; trembling of 
the whole body as if from fright ; difficulty of deglu- 
tition; spasms are often excited when water is 
placed at the lips of the Stramonium patient ; under 
Stramonium, the sexual desires of both sexes are 
greatly increased. 

Special Sphere of Action. — Chorea, epilepsy, hy- 
drophobia, hysteria, delirium tremens, and, most of 
all, acute mania when the patient rises to a condi- 
tion of mental frenzy, far surpassing the exaltation 
of the Hyoscyamus case, but when the actual in- 
flammatory condition of the cerebrum is of a milder 
degree than that found under Belladonna. This 
remedy will be found of service when the patient is 
greatly agitated and extremely fearful of everjrthing 
that he hears or sees. He has the horrors, so to 


Speak, and is in constant dread of being attacked by 
all kinds of terrible animals. One patient who at 
times imagines that snakes are pursuing her, has 
frequently been quieted, and this symptom dispelled 
by a few doses of Stramonium. The nurse in charge 
has noticed this eflfect, and when the vision of snakes 
appears to this patient, she sends to the attending 
physician, and asks for some of the ** snake medi- 
cine *' for the patient. Stramonium is a remedy 
adapted to the relief of maniacal attacks which 
sometimes appear in paretics before or after epilepti- 
form seizures. 


General Action, — It produces a chronic irritation 
and hyper-excitability of the male genital organs, 
particularly of the prostatic urethra and the adja- 
cent seminal ducts ; and secondarily develops all the 
physical and mental symptoms of spermatorrhea. 

Brain and Spinal Cord, — Stupefying headache, or 
as if a round ball were in the forehead, which per- 
sists even when shaking the head. 

Mind, — Very peevish ; easily offended ; becomes in. 
•dignant; thinks the least thing done is a premedi- 
tated insult; hypochondriacal or apathetic mood; 
prefers solitude, and is shy of the opposite sex ; ob- 
tuseness of mind ; thoughts vanish while speaking or 

Sleep. — ^Uneasy sleep, with anxious dreams, or 
dreams of the previous day's work. Amorous 
dreams, with seminal emissions. 

Accompaniments, — Weak, pale and sallow, with 
dark rings beneath the eyes, from masturbation or 
excessive sexual intercourse. Great lassitude and 
indolence; eczematous eruptions; pains in the long 


bones ; excoriating coryza, and relaxation of the ali- 
mentary canal, with desire for spices, wine or other 

Special Sphere ot Action. — It finds its principal 
employment in removing the results of excessive 
masturbation in either sex. These cases are weak, 
firetfiil, lacking in self-control, unable to concentrate 
the mind ; their nervous systems are exhausted, and 
their own ailments are the constant subject of their 
contemplation, and should, in their opinion, be a. 
topic of unfailing interest to every one else. 


General Action. — It acts upon the ganglionic ner- 
vous system, and it works its eflfects most pro- 
foundly throughout the entire vegetative sphere 
Every organ in the body is affected by the adminis- 
tration of Sulphur ; but we look for its most promi-^ 
nent results in the skin, the mucous membranes, the 
lymphatic glands, and the venous circulation. 

Brain and Spinal Cord. — Sulphur produces a rush, 
of blood to the head; a pressive frontal headache^ 
w^orse in the morning; headache in the vertex as 
from a weight ; a headache with vertigo while walk- 
ing or stooping; a headache, with great confusion 
in the head, and a sensation as if a band was bound- 
around the forehead (also Cocculus and Mercurius); 
there is stiffness in the neck and back ; bruised pain 
in the small of the back and the coccyx; tearing, 
drawing, rheumatic pains in the shoulders, arms and 
legs ; burning in the soles of the feet. 

Mind. — Intense anxiety and apprehension, espe- 
cially in the evening (also Calcarea Carbonica) ; in- 
dulgences in philosophical speculations are followed 
by abnormal mental exhaustion, and an inability ta 


hold his mind to work upon any subject; at times 
fretful and ill-humored ; at times indolent and indis- 
posed to exercise ; at times sad, melancholy, inclined 
to weep, and despair of salvation. 

Sleep, — Often wakeful during the entire night; 
when the patient does sleep he awakens frequently 
(also Phosphorus); anxious and vivid dreams accom- 
panied by startings during sleep, especially soon 
after falling asleep ; insufficient sleep at night, and ir- 
resistible drowsiness during the day. 

Accompaniments, — Great sensitivess of the scalp 
and skin generally ; sensitiveness of the eyes to light ; 
sensitiveness of the ears to loud noises ; toothache, 
with great sensitiveness to cold water and cold air ; 
distention of the abdomen from incarcerated flatu- 
lence, and great sensitiveness of the abdomen to 
touch ; hoarseness ; dry cough in the evening or on 
waking ; pains and sensitiveness in the joints. The 
Sulphur patient is sensitive in all his organs, and is 
opposed to all external impressions. He dreads ex- 
ercise or contact with others; he dreads fresh air; 
he dreads to take a bath, on account of being so in- 
tensely sensitive. 

Special Sphere of Action. — Sulphur is particularly 
adapted to lean, sensitive and phthisical persons 
who are inclined to religious melancholy; such pa- 
tients become depressed and discouraged because 
their minds are constantly disturbed by every im- 
pression or experience in life. We are obliged to pre- 
scribe Sulphur for the insane more on account of 
the external symptoms than because of any special 
mental characteristics. As a characteristic of the 
Sulphur patient, it has been said that he uses his 
sleeves both for ** handkerchief and looking-glass.*' 
He is dirty, and looks dirty; has an aversion to 


water, and to washing; the skin is harsh and un- 
clean; the habits are untidy. Mentally, he is irri- 
table and a chronic grumbler. Sulphur is frequently 
useful in the treatment of patients with chronic 
mania who attach great value to trifling objects, 
who dress themselves up in rags, wear paper crowns, 
and imagine that they are kings and queens. The 
Sulphur patient is selfish, and is anxious about his 
own salvation, but indifferent to that of others. In 
cases of this sort. Sulphur is usefiil as a constitu- 
tional remedy, and it prepares the system for the 
beneficial effects of other remedies. When mental 
symptoms are not well pronounced in a case of in- 
sanity, a few doses of Sulphur will often lead the pa- 
tient to disclose characteristic conditions of the 
mind, and insane delusions which have heretofore 
been concealed. 


General Action, — It produces a tendency to acrid 
secretions, especially about the anus and genital or- 
gans ; constitutionally, it produces partial disorgani- 
zation of the blood, and a tendency to wasting of 

Brain and Spinal Cord. — Dull confusion in the 
head ; vertigo as soon as the eyes are closed, or upon 
suddenly turning the head. (Lachesis has vertigo 
from looking steadily at one object). Headache as if 
a nail were driven into the head (also Ignatia). 

Mind, — Disinclined to be touched or even ap- 
proached ; thinks he is made of brittle material and 
may break; thinks his limbs are separated (also 
Baptisia) ; or that a living animal inhabits his abdo- 
men, which he feels moving there. Either hurried in 


manner and ill-humored, or is unable to recall needed 
words, and is slow in speech and thought. 

Sleep. — Falls asleep late owing to persistent rest- 
lessness; lascivious dreams without emission of 
semen, wakes. unrefreshed. 

Accompaniments. — Warty growths upon the skin 
or mucous membranes, seedy or cauliflower-like in 
structure. Sight blurred ; sees apparitions upon clos- 
ing the eyes; greenish yellow gonorrhea; neuralgia, 
beginning over the eye, and seeming to extend back- 
ward over the head. (Gelsemium and Spigelia extend 

Special Sphere of Action.. — It is called for in states 
of mental depression and apathy, with desire to be 
left alone, when this frame of mind follows direct and 
personal knowledge that the way of the transgressor 
is hard. Thuja corrects the physical susceptibility 
which adds to the severity of non-syphilitic venereal 
disease, and removes the lowness of spirits, self-de- 
preciation and loathing of life which is often found 
with severe disease of the sexual organs. In ordi- 
nary hypochondriacal melancholia thje delusion that 
a living creature is in the abdomen, or that his mem- 
bers are changed in structure, will not infrequently 
guide to its successftil application. 


General Action. — This drug acts upon the cerebro- 
spinal system, at times to the extent of producing 
convulsions; it disorganizes the blood, and impairs 
the circulation ; it produces collapse, vomiting, purg- 
ing, spasmodic colic, and clammy perspiration. 

Brain and Spinal Cord. — Congestion of the brain 
when stooping ; headache as if the head would burst ; 
dull pressure in the vertex ; coldness as if ice were on 


the vertex; paralytic weakness of the limbs; limbs 
feel as if asleep ; hands and feet feel bruised and icy 
cold ; cramps in the calves of the legs. 

Mind. — ^Anxiety and apprehension ; a tendency to 
weep, and howl, and scream over some dreaded mis- 
fortmie; tendency to tear and cut clothing; when 
the rage of mania subsides, there is a tendency to 
converse about religious matters; the religious na- 
tures of the Veratrum patients become chameleon- 
hued in their manifestations ; they pray and curse in 
alternation for many hours in succession; finally 
these patients despair of salvation, and of their po- 
sition in society. When disengaged from religious, 
contemplation, the Veratrum patients are inclined to 
gossip, to find fault with others, to scold their 
friends, and to call their neighbors hard names. The 
Veratrum patient sometimes fancies herself preg- 
nant, even w^hen eighty or ninety years of age. 

Sleep. — At times very sleepy and drowsy ; at times 
exalted and sleepless for days and nights in succes- 
sion, sleeplessness from undue mental activity, pre- 
ceding a state of physical collapse. 

Accompaniments. — Pale, sunken face, with blue 
nose, and cold perspiration on the forehead ; violent 
vomiting, first of food, and then of green, slimy^ 
viscid liquid ; profiise, painful and violent diarrhea ; 
discharges sudden and involuntary, with cramping 
pains in the bowels, and in the calves of the legs; 
great difficulty in respiration; palpitation of the 
heart, with anxiety ; sudden failure of the strength • 
extreme prostration, with coldness and a tendency 
to cramps. 

Special Sphere of Action.— Acute mania with rapid 
exhaustion; acute dementia with prostration and 
coldness of the extremities ; acute melancholia with 


intense anxiety and despair of salvation, particu- 
larly in \7omen whose menses have been suppressed, 
or in women who fancy themselves pregnant. 


General Action. — Acts upon the cerebrospinal 
system, and especially upon the pneumogastric 
nerve, disturbing the circulatory apparatus, and 
causing congestion and inflammation of the brain 
and other organs; it produces intense prostration 
and tendency to spasms ; it causes a strong beating 
of the heart, and a quick pulse, but a slow respi- 

Brain and Spinal Cord, — Headache proceeding 
from the nape of the neck ; active congestion of the 
brain, followed by vomiting; cutting pains in the 
neck and shoulders; cramps in the legs and hands; 
shocks like electricity pass rapidly through the limbs ; 
convulsive twitchings of all the muscles of the ex- 

Mind. — Intensely quarrelsome and delirious ; from 
a condition of excitability and quarrelsomeness the 
patient passes into a state in which she is sullen, 
suspicious, and distrustful of those around her ; the 
Yeratrum Viride patient has in mind a constant fear 
that she will be insane (also Sepia, Calcarea Car- 
bonica and Lilium Tigrinum) ; also thinks she will be 

Sleep. — ^Restless each night, but generally secures 
some sleep ; is disturbed by frightfial dreams of being 
on the water, and of being drowned. 

Accompaniments. — Convulsions before, during 
and after labor; intense nausea and vomiting; cut- 
ting neuralgic pains in the abdomen ; profuse urine, 
which is pale ; active congestion of the chief organs 


of the body ; slow, weak pulse, or palpitation, with 
fluttering sensation in region of the heart, with quick 

Special Sphere of Action. — Puerperal mania ; gen- 
eral paresis ; particularly after convulsions ; epileptic 
mania, with frequent convulsive attacks ; hysterical 
mania ; melancholia, with a tendency to chorea ; mel- 
ancholia or mania following cerebrospinal fever. 


General Action. — Its general action resembles that 
of lead in the physical weakness produced through 
nerve exhaustion and anemia. The cerebrospinal 
system is most affected. 

Brain and Spinal Cord. — Sharp, lancinating head- 
aches low in the occiput, or in the root of the nose. 
Burning pain along the whole course of the spinal 
cord; a sense of formication in the limbs; cannot 
hold the feet still ; the muscles jerk voluntarily ; the 
hands tremble; sharp pains are experienced along 
the course of the peripheral nerves- 
Mind. — Sad, morose and dejected, with thoughts 
of death, which he considers indifferently and with- 
out fear ; or, fretful and irritable, with great aversion 
to noise ; starts at every unexpected sound. Again, 
there may be difficulty in comprehending, which 
leads the patient to repeat all questions before en- 
deavoring to answer. 

Sleep. — Sleeps poorly; dreams of filth, of being 
pursued, or of terrifying experiences ; wakens in a 

Accompaniments. — Nausea and vomiting as soon 
as food touches the stomach ; hydraemia, venous con- 
gestions, and a tendency to varicose veins m the ex- 
tremities ; dryness and thickening of the skin. 


Special Sphere of Action, — When prolonged men- 
tal overwork and close confinement have produced a 
state of forgetfnlness, mental weakness, inability 
to apply the mind, broken and tinrefreshing sleep, 
Zincum becomes a most valuable remedy, aided by 
rest, and change of scene. Many cases of melancholia 
present mental exhaustion as their immediate cause, 
and are helped by its administration ; and it is used 
when defective reaction and lack of trophic power 
retard recovery. 



Aconite 264-266 

mania 237, 241 

melancholia 265 

Acute delirious mania . , , 143 

diagnosis 143-144 

prognosis 144 

symptoms 144 

Acute mania 132 

bed treatment for . . .215 

causes 128 

illustrative cases . . 136-137 

prognosis 136 

remedies 237 

Acute delirious melancholia. 116 
illustrative case . . . .119 

symptoms .116 

treatment 117 

Acute melancholia 100 

bed treatment for . . .215 

delusions 95 

illustrative case .... 102 

remedies 233 

suicide 102 

symptoms loo-ioi 

terminations 102 

Acute dementia 162 

causeis 163-166 

differential diagnosis 

160, 170 
hereditary predisposi- 
tion 164 

pathology 180 

prognosis 169 

symptoms 168 

treatment 243 


Agaricus muscarius 266 

Age of brain maturity ... 17 

Agnus castus 243 

Alcoholic dementia .... 176 

pathology jgo 

Allen J4Q 

Alumina 267 

Anacardium 268 

dementia 243 

mental weakness . . . 235 
Antimonium crudum .... 269 
Antimonium tartaricum . . 270 

Appetites, the 25 

Apis mellifica 271 

dementia 243 

Arachnoid, the ..... n 
Argentum nitricum .... 272 

Arnica 273 

Arsenicum 274 

mania 276 

melancholia . . . 233, 276 

neuralgia 276 

sleeplessness 276 

Artificial feeding 221 

Aurum metallicum . . 276-277 

melancholia 233 

Automatic fire extinguisher. 255 
Avenasativa in sleeplessness 63 

Baillarger hq 

Bain 22 

Bakery 260 

Ball . . So 

Baptisia 277 

mania 242 




Baths 217 

Bayle 182 

Bedlam 71 

Bedstead 251 

Bed treatment 215-217 

advantages 216 

Bell 182 

Belladonna 278 

mania 237 

sleeplessness 65 

Blandford 82, 146 

Brain, the human 9 

capabilities 26 

coverings 10 

development 16 

functions 17 

hemispheres 12 

maturity 17 

membranes 11-12 

seat of mind 20 

uses 27 

ventricles 15 

weight 16-17 

Brigham 182 

Boiler-house 261 

Browne .... 146, 162, 1671 169 

Bryonia 280 

peevishness 241 

Bucknill 157 

Bucknill & Tuke iii 

Buildings for care of the 

insane 247 

Burton 35 

Cactus grandiflorus .... 281 
melancholia 235 

Calcarea carbonicum . . . 282 
dementia 243 

Calcarea phosphoricum . . 284 
dementia 243 

Calmeil 182 


Camphor, 284 

Cannabis indica 285 

Cantharis 286 

mania 242, 243 

Capabilities of the brain . . 26 

Cardan 62 

Catalepsy in acute dementia 16& 
cannabis indica .... 285 

Causticum 288 

Cerebellum, the 16 

Cerebrum, the 12 

Chamomilla 289 

peevishness 234 

sleeplessness 65 

China 290 

Chronic dementia 170- 

pathology 180 

prognosis 172 

symptoms .... 170-172 

Chronic mania 141 

definition 142 

delusions 142 

prognosis 142 

Chronic melancholia . . . 105 
illustrative case .... 106 

symptoms 105 

terminations 105 

Cicuta virosa 292 

Cimicifiiga 292 

melancholia .... 236 

sleeplessness 65 

Circular mania 145 

Classification of mental ac- 
tivities. Bain 22 


142, 146, 155, 201, 202, 203 
Coca er3rthroxylon in sleep- 
lessness 63 

Cocoon, the 220 

Cocculus 294 

Coff ea cruda 295 




CojQfea hysteria 234 

sleeplessness 65 

Colchicum 296 

Cold storage building . . .261 

Colocynth 296 

Combe 76 

Commitment, requirements 

for 85 

blank forms . . . . 85 
contraindications . • 92, 93 

necessity 92 

Compendium of materia med- 

ica 264 

Conditions for a good mem- 
ory 22 

Congregate dining-rooms . 259 
Conium maculatum .... 297 

Conscience, the 24 

Constipation, treatment of . 135 
Cotton felt mattress .... 258 
Convolutions, brain .... 13 
Cuprum aceticum in epilep- 
tic dementia 243 

Cuprum metallicum .... 298 

Damiana in masturbatic de- 
mentia 243 

Daute 208 

Decorations in hospitals . . 257 

Delusions 77 

causes 78 

varieties 79 

Dementia 159-181 

differential diagnosis . . 160 

forms 161 

nature and definition . 159 

pathology 180 

remedies 243 

Dementia, acute 162 

causes 162-166 

differential diagnosis . . 160 


Dementia, hereditary predis- 
position 163-164 









pathology .... 

prognosis .... 

symptoms .... 

treatment .... 
Dementia, alcoholic . 

pathology . . . 
Dementia, chronic . 

pathology .... 

prognosis .... 

symptoms .... 
Dementia, epileptic . 
Dementia, katatonic . 
Dementia, masturbatic 

remedies . . 

symptoms . 

treatment . 
Dementia, organic 

causes . . . 

prognosis . . 
Dementia, primary 


Anacardium . 

differential diagnosis 

III, 160 
Dementia, remedies .... 243 

Anacardium 243 

Apium virus 243 

Calcaiea carbonicum . . 243 

Calcarea phosphoricum 

243, 284 

Phosphoric acid . . 243, 321 
Dementia, senile . . . 177-180 

diagnosis ..... 180 

symptoms 178-179 





Dementia, terminal . . 

Desires, the 

Development of brain . 

Diathesis, the insane . . 

causes, acquired . . 




Diathesis, causes, inherited . 52 

clinical case 35 

evidences 45 

prevention 48 

remedies 50 

Dickens , . . . . 75, 127, 46 

Dietetics 223-227 

Digitalis 299 

melancholia 235 

Dining-rooms 259 

Diogenes 35 

Disputed forms of mania . . 155 

Duncan 31 

Dura mater, the 11 

Durham 56, 201 

Dynamo plant 261 

Earle 182 

Emotions, the 24-25 

Enforced protection . . 218-220 

protection sheet . . . .218 

Epileptic dementia . . . .175 

Epilepsy, nursing 244 

Epilepsy, remedies .... 243 

Aconite 266 

Argentum nitricum . . 272 
Cuprum metallicum . . 298 
Oenantha crocata . . . 243 

Silicea 244, 329 

Esquirol 37, 94, 160 

Feeding the insane . . . .221 

frequency 224 

Ferrier 19 

Ferrum metallicum .... 300 

Fire escapes . . 257 

Fire extinguishers 256 

Fire protection 254 

Fleming 55 

Fleurens 19 

Food, selection of 226 

Forced feeding 221 


Fox 157 

Furnishings 257 

Galen 62 

Gelsemium 301 

melancholia . . . 235, 302 

sleeplessness 65 

General paresis .... 182-210 
bed treatment .... 205-6 

causes 200-2 

convulsions 190 

definition 183 

differential diagnosis 

illustrative cases . . 191-197 

pathology 203 

physical signs . . . 1 86-191 

prevention 207 

prognosis 205 

stages 184 

symptoms .... 1 86-1 91 

treatment 205-206 

General paresis, remedies . 244 

Agaricus 266 

Cannabis indica .... 285 

Cicuta . 292 

Cimicifuga 292 

Hyoscyamus 305 

Ignatia 307 

Mercurius 314 

Veratrum viride .... 339 

Glonoin 302 

Grauvogl • • 31 

Hahnemann . . . . 64, 71, 232 

Hallucinations 80 

causes 81 

influence on prognosis . 83 

Heating 250 

methods 250-254 

Helleborus niger 303 

Hemispheres, brain .... 12 




Hepar sulphur 304 

Hippocrates 70 

Hitzig 19 

Home treatment of insanity 212 
Hospital buildings .... 248 

arrangement 248 

construction 248 

cottages 250 

decorations 257 

fire protection .... 254 

heating 250 

lighting 250 

location 247 

size 247 

ventilation 250 

wards 249 

Hospital construction . . . 245 

bakery 260 

boiler house 261 

buildings 247 

cold storage plant . . .261 

dining-rooms 259 

dvnamo room 261 

kitchen 260 

laundry 261 

outbuildings 262 

site 246 

Hospital idea, the . . . 72, 231 

Hot milk . 224 

Hubbard 34 

Hughlings-Jackson .... 56 
Huxley, classification of . . 16 

Hyoscyamus 305 

mania .... 237, 238, 239 

sleeplessness 66 

Hypericum 306 

Hysterical mania 155 

Idiocy .... 
Ignatia .... 




Illusion 83 

Imbecility 160 

Intellect, seat of 20 

Intellectual faculties .... 21 

Intelligence 23 

Insane diathesis 32 

causes, acquired .... 38 
causes, inherited ... 34 

clinical case 35 

evidences 45 

prevention 48 

remedies 50 

Insane, early care of the . . 71 
Hahnemann on care of 

the 71 

hospital care of the . . 72 
Insanity, classification ... 72 
American classification 74 
among ancient peoples . 70 
British classification . . 73 
cured by traumatism . . 151 

definitions 76 

earliest referenoe ... 69 
from a legal sta'ndpoint 76 
general treatment . . .214 
medical treatment . . . 232 

theories 75 

Insomnia '68 

causes 57 

remedies 62 

Iodine 309 

Jeremiah 70 

Johnson 132 

Judgment, the 23 

Kali bromidum in sleepless- 
ness 63 

Katatonic dementia .... 177 
Kindness in care of the in- 
sane . 214 




Kitchen . 360 

Kleptomania 156 

Lachesis 310 

mania 241 

I^Lundry 261 

Laurocerasus in epiplepsy . 243 
general paralysis . . . 244 

Lemnius 62 

Lighting of insane hospitals 250 

lyilium tigrinum 312 

malancholia 236 

Lobes of brain 13 

Localization of brain func- 
tions . 18 

Longet 19 

Lycopodium 313 

Lypemania 94 

Mania 127-158 

causes 128 

forms 131 

pathology .... 156-157 
Mania, acute delirious . . .143 

diagnosis 143, 144 

prognosis 144 

symptoms 144 

Mania, acute 132 

bed treatment for . .215 

causes 128 

illustrative cases . 136, 137 

prognosis 136 

remedies 237 

Mania, chronic 141 

definition 142 

delusions . .... 142 

prognosis 142 

Mania, circular 145 

Mania, disputed forms . . . 155 

Mania, hysterical 155 

Mania, moral 156 

Mania, periodic 145 


Mania, puerperal 153 

causes 153 

illustrative case .... 155 

remedies 305-340 

Mania, recurrent • • . . 145 

Mania, remedies 237 

Aconite 237,241 

Agaricus 266 

Arsenicum 274 

Baptisia 242, 277 

Belladonna . . 237, 239, 278 

Cantharis 242 

Glonoin 302 

Hyoscyamus . 238, 239, 305 

Lachesis 241 

Nux vomica 241 

Picric add 287 

Platina 323 

Rhus toxicodendron . . 242 

Spongia 330 

Stramonium .331, 237, 239 

Sulphur 242, 334 

Veratrum album 

239» 240, 337 

Mania, subacute 138 

Nux vomica 241 

Mania, syphilitic .... 152 

Mania, traumatic 146 

frequency 146 

illustrative cases . 147, 150 

pathology 146 

symptoms 146 

Marryatt 127 

Masturbatic dementia . . .173 

remedies 243 

symptoms ... . 174 

treatment 174 

Materia medica, compendium 


Mattress 258 

Maudsley 94 




Menander 68 

Medulla oblongata i6 

Melancholia ..... 94-126 

causes 95i 99 

definition, Maudsley*s . 94 

forms 99, ICO 

prevalence 123 

prevention 123 

Melancholia, acute .... 100 
bed treatment f or . . .215 

delusions 95 

illustrative case .... 102 

remedies 233 

suicide 102 

symptoms loo-ioi 

terminations 102 

Melancholia, acute delirious. 116 
illustrative case . . . .119 

symptoms 116 

treatment 117 

Melancholia with agitation. 115 

Melancholia attonita . . . .110 

causes 114 

differential diagnosis . . iic 
illustrative case . . . .117 

remedies 118 

symptoms 111-113 

terminations 113 

Melancholia, chronic . . . 105 
illustrative case .... 106 

symptoms 106 

terminations 105 

Melancholia, hypochondri- 
acal 121 

Melancholia, remedies . . . 233 

Aconite 264 

Actea racemosa .... 236 

Alumina 267 

Arsenicum .... 233, 274 

Aurum 233, 276 

Cactus 235, 281 


Melancholia, Calcarea car- 

bonicum 282 

Coffea cruda . . . 234, 295 

Digitalis 235, 299 

Ferrum metallicum . . 300 

Gelsemium 234 

Helleborus niger . . . 303 

Ignatia 234, 307 

Iodine 309 

Lilium tigrinum . . 236, 312 

Lycopodium 313 

Mercurius 314 

Natrum muriaticum234, 316 

Nux moschata 235 

Nux vomica 318 

Opium .... 235-236, 320 

Podophyllum 324 

Pulsatilla 235, 324 

Sepia 236, 328 

Silicea 329 

Stramonium 331 

Sulphur 334 

Thuja 336 

Veratrum album . . 236, 337 
Zincum metallicum . . 340 
Melancholia with resist- 
ance 115 

Melancholia, simple .... 100 
Melancholia with stupor . . 1 10 

causes 114 

differential diagnosis . . 1 1 1 
illustrative case . . . .117 

remedies 118 

symptoms 111-113 

terminations 113 

Melancholia, subacute . . . 100 
Membranes of the brain . . 11 

Memory, the 21 

Mercurius 314 

Mental processes 23 

Michelet 35 




Mickle 183 

Milk, use of 223 

Mitchell. S. Weir 62 

Mizaldus 62 

Mode of addressing the in- 
sane 84 

Monomania 155 

Moral hygiene 227 

Moral mania 155 

Natrum muriaticum . . . .316 

melancholia 234 

Neuroglia, the 13 

Neuron, the 13 

Nerve cells 13 

Nerve fibres 13 

Nitric acid 317 

Ntix moschata in melan- 
cholia 235 

Nux vomica 318 

sleeplessness 66 

subacute mania .... 241 

Occupation for the insane . 220 
Open-door system . . . 250 

Operations 228-230 

Opium 320 

melancholia 236 

mental weakness . . . 235 

Organic dementia 176 

causes 176 

prognosis 176 

Orificial surgery 228 

Outbuildings 262 

Paranoia . 


illustrative case . . . 


Paine*s feeding apparatus 
Pantries in hospital wards 
Passiflora in sleeplessness 







Paresis, general 182 

bed treatment for . . .215 

causes 200 

convulsions 190 

definition 183 

differential diagnosis . 183 

illustrative cases . . . 

191* 194, 198 

pathology 203 

physical signs ... . 186 

prevention 207 

prognosis 205 

stages 184 

symptoms .... 185 

treatment 205 

Paroles 250 

Patients, commitment ... 85 

clothing required for . 91 

Periodic mania 145 

Phosphoric acid 321 

mental weakness . . . 235 

dementia 243, 288 

Phosphorus 321 

Phrenalgia 94 

Pia mater 12 

Picric acid 287 

Pinel 72 

Piscidia in sleeplessness . . 67 

Platina 323 

Podophyllum 324 

Primary dementia 161 

Agaricus 266 

Anacardium 268 

differential diagnosis 

III, 162 

Processes of mind ... .24 

Protection sheet . 

Puerperal mania . 
causes . . . 
illustrative case 

218, 219 

• . 153 

• • 153 
. .305 

• • 153 




Puerperal mania, Veratrum 

viride 339 

Pulsatilla 324 

melancholia 235 

Pyromania 156 

Reade 127 

Recurrent mania 145 

Requirements for commit- 
ment in New York .85 
examination by two 
qualified medical ex- 
aminers in lunacy . . 85 
judicial order of com- 
mitment by a judge 
of a court of record . 88 
personal service .... 87 

petition 86 

statement of financial 
condition of patient . 88 
iR^est in the care of the in- 
sane 215 

advantages 216 

Rhus toxicodendron . . . 326 

Rindfleisch 157 

Rush 94, 142 

Sanitariums 212 

Samuel 69 

Scalp, the 10 

Scott 127 

Secale cornutum 327 

Senile dementia .... 177-180 

diagnosis . . . . " 179-180 

symptoms .... 177-180 
Sepia 328 

melancholia 236 


52-55, 100, 127, 170, 183 
Silicea 329 

epilepsy 244 

Site for hospital for the in- 
sane 246 

Skae 146 

Skull, the 10 

Sleep, definition of ... . 55 
anemia of brain .... 55 

causes 56 

induction of, .... 57-59 

Sleeplessness 62 

causes 57 

remedies 63-67 

Solanum carolinense in epi- 
lepsy 244 

Solariums 248 

Spencer, Herbert 41 

Spongia 330 

Staphisagria 333 

State hospitals 213 

Steam heating 253 

St. Dymphna 71 

Stimulants 227, 245 

Stramonium 331 

mania 239 

sleeplessness ..... 67 
Subacute mania . . . . .138 
Subacute melancholia . . . 104 

Suicide, danger of 221 

Sulci 13 

Sulphur 334 

mania 242 

Syphilitic mania ... 152 

Tarantula in mania .... 242 
Terminal dementia .... 162 

Thuja 336 

Traumatic mania ..... 146 

frequency 146 

illustrative cases . 147, 150 

pathology 146 

symptoms 146 

Tristimania 94 



Treatment of insanity . 21 1-23 1 

amusements 220 

artificial feeding . . .221 

home 212 

in large hospital wards . 215 

means for 214 

medical 232 

moral hygiene . . . .227 

occupation 220 

rest in bed .... 215-218 

sanitarium 212 

state hospital 213 

surgical operations . .228 

Van der Kolk 274 

Velpeau . ... 19 
Ventilation 250 


Ventricles, brain 15 

Veratrum album 337 

history 240 

mania 239, 240 

melancholia 236 

sleeplessness 67 

Veratrum viride 339 

mania 241 

Wards^ arrangement of . . 248 
Ward dining-rooms .... 259 
Weight of brains .... 16-17 

Will, the 24 

Worry 58, 97 

Zincum metallicum